Peritonitis prevention in continuous ambulatory peritoneal dialysis.

Although peritonitis remains the major cause of morbidity in CAPD, peritonitis rates are declining in European and other countries. This article reviews approaches that are both decisive and promising concerning the prevention of peritonitis in CAPD. Clinical results with both reusable and single-use Y sets are discussed. These systems appear to have a significant impact on the reduction of intraluminal contamination, particularly Staphylococcus epidermidis. The importance of the flush-before-fill technique is reviewed in the context of the new disposable Y sets. In vitro studies confirm that 100 mls of fresh dialysate flushed from the new bag to the drainage bag at the appropriate time during the exchange can eliminate microorganisms that do not possess adherence factors, providing long periods of incubation are not encountered. Future prevention measures for the reduction of Staphylococcus aureus peritonitis are discussed in light of evidence identifying pre-CAPD nasal carriers as high risk patients for subsequent exit-site infection and S. aureus peritonitis. These measures include methods such as the application of antibiotics such as mupirocin to the anterior nares before and during CAPD. The roles of intraperitoneal IgG therapY and staphylococcal vaccination as additional therapeutic approaches to infection control in peritoneal dialysis are also discussed.