Infectious peritonitis. The main complication of intermittent peritoneal dialysis.

Infectious peritonitis was studied in 164 patients with renal failure receiving 24,282 peritoneal dialyses over a five-year period. One hundred and fifty nine episodes were registered in 93 patients. The overall incidence was 0.66 episodes per 100 dialyses. Two epidemics accounted for a higher incidence during the first half of the study, while the incidence of endemic peritonitis remained unchanged. Infectious peritonitis was the most common complication among out-patients and was the cause of drop out in 39 per cent of the patients transferred to haemodialysis. The calculated mortality from peritonitis was 0.08, corresponding to one fifth of all deaths. The case fatality rate was 0.14. The most common aetiological microorganisms were Staphylococcus aureus and micrococci, accounting for 50 per cent of the cases. Forty six per cent of the cases caused by Staphylococcus aureus were preceded by wound or catheter tunnel infections with the same strain. This points to the abdominal skin flora as the main source of endemic peritonitis. However, further epidemiological studies are needed to elucidate how the skin saprophytes reach the peritoneal cavity.