INFECTING ORGANISMS IN CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS PATIENTS ON THE Y-SET

Disconnect systems for performing continuous ambulatory peritoneal dialysis (CAPD) use a flush-before-fill technique that should theoretically reduce the peritonitis caused by touch contamination. However, little information about the infecting organisms in CAPD-related infections using disconnect systems is available. We performed a retrospective matched-case controlled study to define the organisms responsible for the peritonitis and catheter infections seen in CAPD patients using the Y-set without disinfectant. One hundred nineteen patients who began CAPD on the Y-set were matched with 119 patients who began CAPD on the standard spike system. Patients were matched for age, sex, race, insulin dependence, and time on CAPD. Infection data were prospectively collected for all patients. Peritonitis, exit site, and tunnel infection rates (expressed as number of episodes per patient-year) were all significantly lower in the Y-set patients (0.56 v 0.94, 0.68 v 1.08, and 0.14 v 0.22, respectively). The lower peritonitis rate in the Y-set patients compared with that found in the standard spike system patients was due to a reduction in Staphylococcus epidermidis (0.17 v 0.26, P = 0.02), polymicrobial (0.014 v 0.06, P = 0.01), other gram-positive (0.007 v 0.09, P = 0.001), and sterile (0.10 v 0.19, P = 0.008) peritonitis. Rates of Staphylococcus aureus and gram-negative peritonitis were not different among the two groups. S epidermidis (0.12 v 0.23, P = 0.0014) and gram-negative (0.12 v 0.18, P = 0.04) exit site infection rates were also lower in the Y-set patients. Similarly, the catheter removal rate for infectious causes was lower in the Y-set patients (0.14 v 0.28, P = 0.004), particularly for removal due to peritonitis (0.05 v 0.12, P = 0.007) and catheter infection (0.04 v 0.12, P = 0.003). Rates of S aureus infections and catheter removals were not different between the Y-set and standard spike patient groups. Disconnect systems reduce some infections caused by touch contamination, eg, those caused by S epidermidis, but have no effect on S aureus infections in CAPD patients. © 1994, National Kidney Foundation. All rights reserved. All rights reserved.