Relapsing CAPD peritonitis is defined arbitrarily as a second episode of peritonitis caused by the same organism that caused the immediately preceding episode and occurring within four weeks of completion of antibiotic treatment for the previous infection. The clinical signs and symptoms of relapsing CAPD peritonitis are similar to those of sporadic CAPD peritonitis. The release of planktonic bacteria from biofilm on the walls of catheters may be a contributing factor in patients with multiple episodes of CAPD peritonitis.
The reappearance of organisms causing infection was documented in 90 patients with more than four episodes of culture-positive peritonitis, of whom 59 (65%) had at least half of their episodes caused by the same organism.5 Sequential analyses for independence revealed that for S. epidermidis and for S. aureus, there was a significantly increased likelihood for these organisms to follow themselves as causative organisms of peritonitis. When the data were analyzed using the Spearman correlation test, the results indicated that the likelihood of repeat infections occurring was significantly greater than by chance alone. Of 67 patients with catheter changes and subsequent peritonitis, only 10 (15%) developed repeat infections with the same organism after the catheter change.
The application of mupirocin ointment to the catheter exit site may be useful for the prevention of recurrent CAPD infections caused by S. aureus. In addition to reducing S. aureus exit-site infections, mupirocin ointment may help decrease the rates of staphylococcal CAPD peritonitis and catheter loss. Whether the ointment should be applied in the nares, and whether it should be used only in staphylococcal nasal carriers, has not been conclusively determined.6
Intracatheter streptokinase (SK) has been advocated as an effective treatment with minimal adverse effects in patients with recurrent CAPD peritonitis. A review of 35 instillations of intracatheter SK in 20 patients with recurrent CAPD peritonitis revealed a high (86%) adverse effect profile consisting of fever, onset of turbid dialysis effluent and/or abdominal pain.7
- Saklayen MG. CAPD peritonitis. Incidence, pathogens, diagnosis, and management. Med Clin North Am. 1990;74:997-1010.
- Chow KM, Szeto CC, Leung CB, et al. A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int. 2005;25:374-379.
- Kim DK, Yoo TH, Ryu DR, et al. Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: a single center’s experience over one decade. Perit Dial Int. 2004;24:424-432.
- Innes A, Burden RP, Finch RG, Morgan AG. Treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis with intraperitoneal urokinase: a double-blind clinical trial. Nephrol Dial Transplant. 1994;9:797-799.
- Finkelstein ES, Jekel J, Troidle L, et al. Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis. Am J Kidney Dis. 2002;39:1278-1286.
- Thodis E, Passadakis P, Vargemezis V, Oreopoulos DG. Prevention of catheter related infections in patients on CAPD. Int J Artif Organs. 2001;24:671-682.
- Nankivell BJ, LakeN, Gillies A. Intracatheter streptokinase for recurrent peritonitis in CAPD. Clin Nephrol. 1991;35:20-23.