Most cases of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) are caused by:

Question

a. Staphylococcus epidermidis and S. aureus.
b. Escherichia coli.
c. Klebsiella pneumoniae.
d. Streptococcus spp.
e. viral agents.

Answer 1

A
More than 13,000 patients with end-stage renal disease are maintained on CAPD. In this treat-ment, fluid is injected into the peritoneal cavity and subsequently removed, which allows the exchange of salts and water and the removal of various wastes in the absence of kidney function. Because the dialysate fluid is injected into the peritoneal cavity via a catheter, this break in the skin barrier places the patient on dialysis at significant risk for infection. Most infections originate from the patient's own skin flora. S. epidermidis and S. aureus are the most common etiologic agents, followed by streptococci, aerobic or facultative gram-negative bacilli, Candida spp., Corynebacterium spp., and others. The oxygen content of peritoneal dialysate is usually too high for the development of anaerobic infection. Among the gram-negative bacilli isolated, Pseudomonas spp., Acinetobacter spp., and the Enterobacteriaceae are frequently observed.