Infection in continuous ambulatory peritoneal dialysis (CAPD): aetiology, complications and risk factors.

Continuous ambulatory peritoneal dialysis (CAPD) was started in the Singapore General Hospital in 1980. Peritonitis and exit site infections have been the major cause of morbidity and catheter loss in CAPD. In 1990, 130 patients were on CAPD and the peritonitis rate was one episode in 20.4 patient months. Gram positive organisms accounted for 54% of the infections of which Staphylococcus epidermidis was the commonest (24%). Catheter removal was required in 14% of the cases and 9% of the patients discontinued CAPD as a result of peritonitis. The exit site infection rate was one episode in 27.5 patient months and the commonest organism was Staphylococcus aureus (54%). Twenty-three (47%) of the cases of exit site infection required catheter removal and 83% of the cases were the result of S. aureus infections. Patients with preexisting exit site infections experienced more episodes of peritonitis. Patients above the age of 50 years experienced more episodes of peritonitis and exit site infection. Sex, diabetes and the duration on CAPD did not influence the frequency of infections. Patients using the UV Germicidal Exchange Device had fewer episodes of peritonitis than those using the conventional spike system.