Exit‐site and catheter‐related infections in peritoneal dialysis: Problems and progress

SUMMARY: Silastic peritoneal catheters are used routinely for peritoneal access in peritoneal dialysis (PD) because they are biocompatible. Catheter insertions are usually succeeded by bacterial adhesion and subsequent colonization of the catheter exit site. Despite the reduction in the proportion of peritonitis due to touch contamination, exit‐site and catheter‐related infections, particularly those caused by Staphylococcus aureus , remain the major cause of catheter loss and technique failure in PD. The peritonitis rate in the global PD population is steadily declining, but as the number of patients on PD increases by about 10% per year the stakes in infection control become greater, and one is forced to consider new options that will reduce the PD patient drop‐out rate. Three areas of promising advances in the prevention of exit‐site and catheter‐related infections are reviewed in this paper: (i) the use of prophylactic antibiotics to eliminate the nasal carriage of Staph. aureus and to reduce exit‐site infections; (ii) the Moncrief–Popovich catheter and implantation technique which reduces bacterial colonization of the catheter exit tunnel; (iii) new catheter implants composed in part of rigid biomaterials with antibacterial properties. This last category includes the silver‐coated silastic PD catheter, significant not only because it has great potential as a replacement for the silastic catheter, but also because it is a reminder that caution must be exercised before fully embracing new treatment options.