Prevention of peritoneal dialysis-related infections

The use of peritoneal dialysis (PD) varies widely from country to country, with the main limitation being infectious complications, particularly peritonitis, which leads to technique failure, hospitalization and increased mortality. A large number of prophylactic strategies have been employed to reduce the occurrence of peritonitis, including the use of oral, nasal and topical antibiotics, disinfection of the exit site, modification of the transfer set used in continuous ambulatory PD exchanges, changes to the design of the PD catheter implanted, the surgical method by which the PD catheter is inserted, the type and length of training given to patients, the occurrence of home visits by trained PD nurses, the use of antibiotic prophylaxis in patients undergoing certain invasive procedures and the administration of antifungal prophylaxis to PD patients whenever they are given an antibiotic treatment course. This review summarizes the existing evidence evaluating these interventions to prevent exit-site/tunnel infections and peritonitis.