Indwelling Peritoneal Catheter Research Articles

Topical antibiotics prophylaxis for infections of indwelling pleural/peritoneal catheters (TAP-IPC): A pilot study.

Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter-related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC. (i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly) and followed up for 6 months. (i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow-up was 121 [median, IQR 19-181] days. All patients tolerated mupirocin well; one patient reported short-term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter-related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. This first study of long-term prevention of IPC- or IPeC-related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies.

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

Transformation of indwelling peritoneal catheter placement for malignant ascites from an inpatient to a day-case service: analysis of patient risk and financial implication

To investigate the impact on patient outcomes, costs, and resources/infrastructure of inserting indwelling peritoneal catheters (IPC) during a day-case instead of an inpatient service. A single-centre, retrospective analysis of patients receiving IPCs over a 4-year period was performed. Patients undergoing a day-case procedure were admitted in the morning for pre-procedural investigations, a 15.5 F PleurX IPC (BD, Wokingham, UK) was inserted, all accessible fluid drained and patients discharged the same day, barring any complications. Using electronic patient records, outcomes and complications (immediate/post-procedural) were recorded. Expenses and re-imbursement tariffs were obtained from the income department. Of 138 IPC procedures, 45.6% were undertaken after formal inpatient admission, 54.3% were undertaken as a day-case. The mean hospital stay was 2.51 bed-days for inpatient procedures (n=63) and 0.31 bed-days for day-case procedures (n=75; p<0.001). Day-case procedures saved 165 bed-days per year. Complication rates were 15.9% and 16% for inpatient and day-case procedures respectively (p=0.98). There was an estimated savings of £1,850.46 per day-case procedure or £138,784.50 annually. The placement of IPCs can safely be performed as a day-case procedure. There were substantial economic benefits as well as improved patient satisfaction, with no compromise in patient outcomes. Day-case IPC insertion is now standard practice at The Christie NHS Trust.

Indwelling Peritoneal Catheter for Ascites Management in a UK District General Hospital: A Cohort Study.

Background: There is no national or local guidance for management of malignancy-related ascites (MRA). Modalities can include large volume paracentesis (LVP) and indwelling peritoneal catheter (IPeC) insertion. Objectives: We set up a local IPeC service and performed a retrospective review with local ethical (Caldicott) approval. We hypothesized that an IPeC service would reduce inpatient stay related to MRA management, would be acceptable to patients, and have minimal complications. Methods: Notes of all patients requiring IPeC insertion were reviewed. Descriptive statistical methodology was applied with continuous data presented as mean (standard deviation (SD); range) and categorical variables as frequencies or percentages. Integrated Palliative Care Outcome Scale (IPOS) scores were collected for IPeC patients. Results: Thirty-four patients were identified. They were predominantly female, with a mean age of 66.6 years and a wide range of cancer diagnoses. Twenty-nine were inserted as day case procedures, and 31 had preceding paracenteses (mean 2). Main complications were leakage (6(17%)), peritonitis (2(5.8%)), and skin infection (1(3%)). IPOS scores showed consistent improvement in symptoms. Conclusions: An IPeC service for malignant-related ascites is acceptable to patients and is associated with manageable complication rates. We present the development of our service and hope for widespread application.

POS-670 Severe Stenotrophomonas maltophilia peritonitis in a patient receiving peritoneal dialysis

Stenotrophomonas maltophilia (S.maltophilia) is an aerobic, non-fermentative, Gram-negative bacillus. It behaves like an opportunistic pathogen affecting individuals with severe debilitation or immunosuppression. In peritoneal dialysis (PD), S.maltophilia peritonitis is associated with a pejorative prognosis and loss of peritoneal catheter in front of its common resistance to different groups of antibiotics including beta-lactams, aminoglycosides and fluoroquinolones. We report a case of S.maltophilia infection related to continuous ambulatory peritoneal dialysis (CAPD) in our PD unit. It's about a 44-year-old female patient receiving peritoneal dialysis since 6 years. She had a past history of hypertension and chronic hepatitis C. It was her first episode of peritonitis after 6 years undergoing peritoneal dialysis. She consulted our PD unit for vomiting, fever, and abdominal pain. At the exam, she was painful, temperature was at 36.5 blood pressure was at 9/5. Blood test and peritoneal fluid analyses were performed. The fluid was turbid, we found 300 cells/mm3 in the peritoneal effluent with 100 % polymorph nuclear. Laboratory data showed C reactive protein at 389, white blood cells at 8700, with a hypokalemia due to abundant diarrhea. The patient was at her third day of antibiotherapy by intra peritoneal gentamycin (0.6mg/kg) prescribed in the emergency room. Our attitude was to continue intra peritoneal gentamycin until 5days, and add intra peritoneal ceftazidim (1g/d) and prophylaxis of fungal peritonitis by fluconazole that was subsequently stopped.Peritoneal fluid culture was positive for a multiresistant S. maltophilia sensitive to ceftazidim and trimethoprim-sulfamethoxazole that was added to the previous treatment. We had an initial transient improvement: decrease of diarrhea with negative culture of peritoneal fluid. (130 nucleated cells with 92% PMN). Unfortunately, after more than 3 weeks of antibiotherapy the cell count increased again(2700 nucleated cells with 100% PMN) and a stenotophomonas maltophila was isolated again in the peritoneal fluid that is why it was decided to remove the peritoneal catheter and transfer the patient definitely to hemodialysis. S.maltophilia has been increasingly recognized as a nosocomial pathogen in patients with immunodepression. It's an uncommon cause of peritonitis in patients under peritoneal dialysis, but it is always a therapeutic challenge because of its resistance to several antibiotics. In many cases the removal of the peritoneal catheter is required . The prognosis of this peritonitis is usually poor and a prolonged attempt of antibiotic treatment would make them prone to further opportunistic infection without saving the catheter. Immune dysfunction due to uremia, anemia, malnutrition … and also, an indwelling peritoneal catheter may be predisposing factors for the S. maltophilia infection in patients undergoing peritoneal dialysis.

Perforation of the ascending colon during implantation of an indwelling peritoneal catheter: a case report

BackgroundTunneled peritoneal drainage catheters are described as an effective and relatively safe method in the management of malignant and non-malignant refractory ascites. Therapeutic advantages, linked to their use, are self-management of ascites and palliative care at home. Complications occur rarely. We describe an ascending colon perforation after implantation of a peritoneal drainage in a patient with refractory ascites due to liver cirrhosis.Case presentationThe 68-year-old male was admitted to the intensive care unit due to severe community acquired pneumonia. The ascites drainage was inserted in order to reduce the intra-abdominal pressure and enable appropriate ventilation. A few hours later, bowel content could be detected in the tube and an abdominal computed tomography confirmed the intestinal perforation. Notably, there was no pneumoperitoneum and peritonitis had not yet set in. The catheter was removed during an emergency laparotomy and sutured closure of both perforation sites was performed.ConclusionPatients with septated ascites and intraperitoneal adhesions are at potential higher risk of bowel perforation during implantation of an indwelling peritoneal catheter. A mini-laparotomy is, therefore, necessary in order to ensure safe implantation and positioning of the catheter in those cases.

Establishing an indwelling peritoneal catheter as a standard procedure for hospitalized patients with ascites: Retrospective data on feasibility, effectiveness and safety.

The use of an indwelling peritoneal catheter system in hospitalized patients with ascites could facilitate patient management by the prevention of repetitive abdominal paracentesis. Despite these possible benefits, the use of indwelling catheters is not widely established. This retrospective study aimed to evaluate the feasibility, effectiveness and safety of the use of an indwelling catheter for ascites drainage in the clinical routine. This retrospective study included all indwelling peritoneal catheter placements in our department in hospitalized patients with cirrhosis between 2014 and 2017. A total of 324 indwelling catheter placements for ascites in 192 hospitalized patients with cirrhosis were included. The catheter (7F, 8 cm) was placed ultrasound-assisted bed-side on the hospital ward. The technical success rate of the catheter placement was 99.7% (323/324). In 17.5% (64/324) the catheter was placed to optimize ascitic drainage prior to an abdominal intervention (e.g. transjugular intrahepatic portosystemic shunt). The median time of catheter retention was 48 hours (8-168 hours) and the median cumulative amount of drained ascites 8000 ml (550-28,000). The most common adverse event was acute kidney injury (49/324, 15.1%); the risk was particularly higher in patients with a Model for End-Stage Liver Disease (MELD) score ≥ 16 (p = 0.028; odds ratio 2.039). Ascitic fistula after catheter removal was observed in 9.6% (31/324). Catheter-related infections occurred in 4.3% (14/324), and bleeding was documented in three cases (0.8%) with one major bleeding (0.3%). The placement of an indwelling catheter for repetitive ascitic drainage in hospitalized patients with cirrhosis can be established in the clinical routine, facilitating patient management. High-MELD patients especially have to be monitored for acute kidney injury.

Spontaneous Bacterial Peritonitis Caused by Listeria monocytogenes

Introduction: Diagnosis of SBP is made if the ascitic fluid shows polymorph nuclear cell count more than 250 cells/mm. Listeria monocytogenes, is an uncommon cause of SBP in the United States. Case Presentation: Patient is a 57-year-old man with a past medical history significant for non-Hodgkin's lymphoma diagnosed three years prior to hospital presentation status post six rounds of Rituximab, Cyclophosphosphamide, Doxorubicin Hydrochloride, Vincristine Sulfate and Prednisone therapy. He presented to the hospital secondary to generalized weakness, consistent temperature of 99.2 Fahrenheit and chills. He had a tunneled indwelling peritoneal catheter for recurrent ascites secondary to peritoneal metastasis. During presentation his vitals were temperature: 98.2 F, heart rate of 101 beats/ min, BP 84/40 mmHg while on norepinephrine, and saturating at 94% on 2 L of nasal cannula. His abdomen was distended, tense with ascites and tender to palpation. His laboratory results were as noted in Table 1. Evaluation with a CT abdomen and pelvis showed moderate ascites and small bilateral pleural effusion. His serum-ascites albumin gradient was 1.3. He was further worked up for an infectious etiology with thoracentesis and peritoneal tap. He was found to have listeria bacteremia as well as positive pleural and ascites cultures for listeria. He initially had received an empiric dose of ceftriaxone and gentamicin, but was transitioned to ampicillin and gentamicin once listeria was identified in the peritoneal fluid and blood cultures. After 7 days of treatment with ampicillin, he remained afebrile with resolution of general weakness and myalgia. He was discharged on ampicillin 2g intravenous every 4 hours for a total of 14 days of treatment. At the time of discharge his repeat blood and peritoneal cultures remained sterile.Table: Table. Laboratory resultsDiscussion: SBP caused by listeria monocytogenes should be considered when there is an inappropriate response to treatment in the first 48-72 hours with patients treated for SBP. Third generation cephalosporin are commonly used for treatment of SBP, however these antibiotics do not have a reliable action against listeria. Ampicillin with or without an aminoglycoside is the treatment of choice. In conclusion listeria is a rare but potentially fatal cause of spontaneous bacterial peritonitis. This case emphasizes the importance of looking beyond meningitis when approaching listeriosis in immunocompromised hosts.

Large-volume paracentesis with indwelling peritoneal catheter and albumin infusion: a community hospital study

BackgroundThe management of ascites can be problematic. This is especially true in patients with diuretic refractory ascites who develop a tense abdomen. This often results in hypotension and decreased venous return with resulting renal failure. In this paper, we further examine the risks and benefits of utilizing an indwelling peritoneal catheter to remove large-volume ascites over a 72-h period while maintaining intravascular volume and preventing renal failure.MethodsWe retrospectively reviewed charts and identified 36 consecutive patients undergoing continuous large-volume paracentesis with an indwelling peritoneal catheter. At the time of drain placement, no patients had signs or laboratory parameters suggestive of spontaneous bacterial peritonitis. The patients underwent ascitic fluid removal through an indwelling peritoneal catheter and were supported with scheduled albumin throughout the duration. The catheter was used to remove up to 3 L every 8 h for a maximum of 72 h. Regular laboratory and ascitic fluid testing was performed. All patients had a clinical follow-up within 3 months after the drain placement.ResultsAn average of 16.5 L was removed over the 72-h time frame of indwelling peritoneal catheter maintenance. The albumin infusion utilized correlated to 12 mg/L removed. The average creatinine trend improved in a statistically significant manner from 1.37 on the day of admission to 1.21 on the day of drain removal. No patients developed renal failure during the hospital course. There were no documented episodes of neutrocytic ascites or bacterial peritonitis throughout the study review.ConclusionLarge-volume peritoneal drainage with an indwelling peritoneal catheter is safe and effective for patients with tense ascites. Concomitant albumin infusion allows for maintenance of renal function, and no increase in infectious complications was noted.

Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites.

The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk. This study aimed to evaluate the risk of bacterial peritonitis (BP) with peritoneal drains in patients with Child-Pugh class B or C cirrhosis and determine their impact on survival. We conducted a retrospective review of end-stage liver disease (ESLD) patients with non-malignant, refractory ascites who had peritoneal drains placed for ≥3 days at Loyola University between 1999 and 2009. Cell counts were performed at drain placement and within 72 h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm(3) . Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic. There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72 h). There was no association between BP and baseline characteristics. Patients who developed BP within 72 h of drain placement had 50% mortality at 5 months compared with 50 months in those without infection (log-rank P ≤ 0.003). In ESLD patients who received an indwelling peritoneal catheter, there was 10% risk of developing BP and significant mortality increase. Though placing drains is not the mainstay of treatment for refractory ascites, we confirm the theoretical adverse risk of peritoneal drains on infection and survival in cirrhotics.

Stenotrophomonas maltophilia infection in patients receiving continuous ambulatory peritoneal dialysis.

BackgroundStenotrophomonas maltophilia is a gram-negative bacillus that has become increasingly recognized as an important nosocomial pathogen, particularly in individuals with severe debilitation or immunosuppression. S. maltophilia is also characterized by its resistance to multiple antibiotics. S. maltophilia peritonitis in CAPD (continuous ambulatory peritoneal dialysis) patients is associated with a poor prognosis and loss of CAPD catheter. No report concerning this entity has been presented in Korea. Therefore, we describe and discuss five cases of the S. maltophilia infection associated with CAPD in three patients with peritonitis and two with exit-site infections.MethodsWe performed a retrospective search for episodes of S. maltophilia infections related to CAPD in our renal unit. The baseline levels of hemoglobin, albumin, cholesterol, BUN and creatinine were compared with age, sex and, if possible, the underlying disease-matched controls.ResultsAll the patients with S. maltophilia peritonitis had diabetes mellitus as the underlying disease. The individual patients also had other significant combined morbidities, such as panhypopituitarism, COPD chronic obstructive pulmonary disease, cerebrovascular accident and myocardial infarction. The level of hemoglobin in these patients was significantly lower than in the controls, and the mean values of serum albumin, creatinine and BUN were also low.ConclusionImmune dysfunction due to uremia, anemia, malnutrition, other comorbidities (e.g. diabetes mellitus), and also, an indwelling peritoneal catheter may be predisposing factors for the S. maltophilia infection in CAPD patients. Once the S. maltophilia infection is diagnosed in CAPD patient, the patient should be treated based on the understanding of this particular organism.

Periodic elevation of complement activation products in peritoneal dialysis effluent.

Peripheral white blood cells (WBCs) of chronic ambulatory peritoneal dialysis (CAPD) patients show a reduced expression of chemotactic receptors and a desensitization to chemotactic factor induced events. Chronic complement activation has been suggested as a cause of such phenomena, resulting from either uremia, the indwelling peritoneal catheter, and/or dialysis fluid stimulation. The presence of complement activation products in peritoneal dialysis effluent was assessed by longitudinal measurement of C3bi in eight patients over a 6 to 8 month period, while peritoneal polymorphonuclear leukocyte (PMN) and monocyte CR3 and C5a receptor expression was quantitated by flow cytometry. In six of eight patients, C3bi levels were stable over time and usually measured less than 5 micrograms/ml. Two other patients showed periodic elevation of C3bi, which was not associated temporally with peritonitis. Further study is required to identify the origin of such activated complement components within the peritoneal cavity. However, no correlation was found between dialysate C3bi levels and peritoneal PMN or monocyte expression of CR3 or C5a receptors. Furthermore, the incidence of peritonitis for the two individuals with elevated C3bi was discordant (1 episode/8 patient months vs. 0 episodes/32 patient months), suggesting little or no relationship between these parameters.

Gastrointestinal disturbances in marathon runners.

The purpose of this survey was to investigate the prevalence of running-induced gastrointestinal (GI) disturbances in marathon runners. A questionnaire was completed by 471 of the estimated 1,750 competitors in the 1986 Belfast City Marathon. Eighty-three per cent of respondents indicated that they occasionally or frequently suffered one or more GI disturbances during or immediately after running. The urge to have a bowel movement (53%) and diarrhoea (38%) were the most common symptoms, especially among female runners (74% and 68% respectively). Upper GI tract symptoms were experienced more by women than men (p less than 0.05) and more by younger runners than older runners (p less than 0.01). Women also suffered more lower GI tract symptoms than men (p less than 0.05) with younger runners showing a similar trend. Both upper and lower tract symptoms were more common during a "hard" run than an "easy" run (p less than 0.01) and were equally as common both during and after running. Of those runners who suffered GI disturbances, 72% thought that running was the cause and 29% believed their performance to be adversely affected. There was no consensus among sufferers as to the causes of symptoms and a wide variety of "remedies" were suggested. GI disturbances are common amongst long-distance runners and their aetiology is unknown. Medical practitioners should be aware of this when dealing with patients who run.

Effect of vancomycin hydrochloride on Staphylococcus epidermidis biofilm associated with silicone elastomer.

Peritonitis is a major complication of continuous ambulatory peritoneal dialysis. Relapsing peritonitis after the cessation of antimicrobial therapy is frequently reported and often involves Staphylococcus epidermidis. To investigate the potential role of catheter-associated biofilm in the pathogenesis of relapsing peritonitis, we describe an in vitro model permitting the development of an S. epidermidis biofilm on silicone elastomer biomaterial. This model has been used to investigate the ability of vancomycin hydrochloride to kill biofilm-encased organisms by using an antibiotic regimen typical of peritonitis therapy. No significant differences were seen between vancomycin-exposed and control groups in biofilm viable and total cell counts after 10 days. Vancomycin-exposed silicone-associated biofilm populations decreased by only 0.5 log10 CFU/cm2 over the study period. MICs and MBCs for the original S. epidermidis suspension were 3.125 and 6.25 micrograms/ml, respectively. For biofilm homogenate suspensions, MICs were 3.125 micrograms/ml, but MBCs were greater than 400 micrograms/ml. These data indicate that the biofilm organisms associated with an indwelling peritoneal catheter may display a form of tolerance, thereby suggesting one possible mechanism behind relapsing peritonitis.

Massive Colonization ofan In-Dwelling Catheter by Penicillium Pinophilum without Peritonitis

This paper describes invasion of an indwelling peritoneal catheter by a fungus. This colonization by Penicillium pinophilum, whose identity was proved by isolation, mycological characterization and in situ examination by scanning electron microscopy, did not cause peritonitis. We have discussed possible causes of contamination and implications of the findings. Fungi rarely are responsible for primary peritonitis in CAPD patients, though increasingly they are recognized as secondary agents (1). Mycetes so far isolated belong to the following genera: Aspergillus, Candida. Drechslera, Fusarium, Mucar, Rhodotorula and Trichosparan (2–10). Recently Pearson et al (II) described Penicillium peritonitis which appeared to have been induced by prolonged antibiotic therapy, following repeated episodes of bacterial peritonitis. A similar sequence was encountered after intestinal perforation (3). In CAPD patients peritonitis caused by fungi does not differ from the more common bacterial peritonitis (3), though at first the clinical symptoms may be attenuated and effluent solution may be clear (6, 11). In some cases however such peritonitis can be particularly severe and persistent (12). In these circumstances the catheter should ∼ removed (2, 13, 14), because then the infection clears without specific antifungal therapy. Colonization of the in -dwelling device is associated with a poor prognosis (15). This report describes a patient with massive colonization of the exposed tract of the Tenckhoff peritoneal catheter with Penicillium without clinical symptoms of peritonitis or changes in the dialysate effluent.

Continuous ambulatory peritoneal dialysis

The potential use of the peritoneum as a dialyzing membrane was recognized as early as 1923 (1, 2). Nevertheless, not until a permanent indwelling peritoneal catheter was developed in 1964 by Palmer et al. (3) and later modified by Tenckhoff (4), did long-term intermittent peritoneal dialysis (IPD) become a practical alternative to hemodialysis. However, due to inadequate dialysis and repeated episodes of peritonitis, the cumulative technique survival on IPD was low (5) and hemodialysis remained the predominant form of dialysis therapy.

Status report on continuous ambulatory peritoneal dialysis in end-stage renal disease

Several new trends in the treatment of patients with end-stage renal disease have begun to emerge in the last few years. Most notable has been the reintroduction of peritoneal dialysis (PD) as a long-term treatment option. The increased use of PD is the result of the development of a long-term indwelling peritoneal catheter, automated dialysate delivery systems, and the view by some investigators that, in certain patients, PD as compared with hemodialysis may be a preferred mode of therapy. In 1978, continuous ambulatory peritoneal dialysis (CAPD) was introduced and demonstrated to be an alternative to traditional intermittent peritoneal dialysis (IPD).¹With CAPD, the patient instills the dialysis solution for four to six hours and exchanges the solution four to five times per day, six or seven days per week. Thus, while the efficiency of dialysis per hour is less with CAPD than with IPD, the clearances per week of

Status Report on Continuous Ambulatory Peritoneal Dialysis in End-Stage Renal Disease

Several new trends in the treatment of patients with end-stage renal disease have begun to emerge in the last few years. Most notable has been the reintroduction of peritoneal dialysis (PD) as a long-term treatment option. The increased use of PD is the result of the development of a long-term indwelling peritoneal catheter, automated dialysate delivery systems, and the view by some investigators that, in certain patients, PD as compared with hemodialysis may be a preferred mode of therapy. In 1978, continuous ambulatory peritoneal dialysis (CAPD) was introduced and demonstrated to be an alternative to traditional intermittent peritoneal dialysis (IPD). 1 With CAPD, the patient instills the dialysis solution for four to six hours and exchanges the solution four to five times per day, six or seven days per week. Thus, while the efficiency of dialysis per hour is less with CAPD than with IPD, the clearances per week of

Prevention of infection during peritoneal dialysis

During the past three years, the procedure for peritoneal dialysis was altered in an effort to reduce the incidence of infection. Three consecutive groups of patients were treated by three different regimens. Initially, in 1964, a large-bore indwelling peritoneal catheter was inserted surgically, and the duration of dialysis was prolonged for periods up to 29 days. Prophylactic antibiotics were not administered but protective isolation of the patient was employed. During that year, peritonitis occurred in almost 50% of patients and was caused solely by enteric organisms. In 1965 and 1966, peritonitis was eliminated by a regimen consisting of prophylactic oral administration of neomycin and employment of a thin stylet-catheter which was introduced percutaneously, used for only two to three days, and reinserted thereafter as necessary. Protective isolation of the patient and prophylactic use of tetracycline in the dialysis fluid appeared to be unnecessary and were abandoned.

Prevention of Infection During Peritoneal Dialysis

During the past three years, the procedure for peritoneal dialysis was altered in an effort to reduce the incidence of infection. Three consecutive groups of patients were treated by three different regimens. Initially, in 1964, a large-bore indwelling peritoneal catheter was inserted surgically, and the duration of dialysis was prolonged for periods up to 29 days. Prophylactic antibiotics were not administered but protective isolation of the patient was employed. During that year, peritonitis occurred in almost 50% of patients and was caused solely by enteric organisms. In 1965 and 1966, peritonitis was eliminated by a regimen consisting of prophylactic oral administration of neomycin and employment of a thin stylet-catheter which was introduced percutaneously, used for only two to three days, and reinserted thereafter as necessary. Protective isolation of the patient and prophylactic use of tetracycline in the dialysis fluid appeared to be unnecessary and were abandoned.