Which of the following statements regarding infection in...

Which of the following statements regarding infection in patients with continuous ambulatory peritoneal dialysis (CAPD) is TRUE? (A) Gram-negative bacteria are responsible for most cases of CAPD peritonitis. (B) Cell count in cases of peritonitis is $>250$ leukocytes. (C) Infection is the most frequent complication of CAPD. (D) The peritoneal catheter should be changed at the first sign of peritonitis.

Which of the following statements regarding infection in patients with continuous ambulatory peritoneal dialysis (CAPD) is TRUE?
(A) Gram-negative bacteria are responsible for most cases of CAPD peritonitis.
(B) Cell count in cases of peritonitis is $>250$ leukocytes.
(C) Infection is the most frequent complication of CAPD.
(D) The peritoneal catheter should be changed at the first sign of peritonitis.

Key Concepts

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD is a renal replacement therapy for patients with end-stage renal disease that uses the peritoneum as a dialysis membrane. It involves the continuous exchange of dialysis fluid to remove waste products, and while it offers greater mobility and independence, it also carries risks, most notably of infectious complications due to the indwelling peritoneal catheter.

Peritonitis in CAPD

Peritonitis is an inflammation and infection of the peritoneal cavity, and it is the most frequent and significant complication of CAPD. The infection can arise from contamination during exchanges or catheter manipulation, requiring prompt recognition and treatment to prevent further complications and preserve the efficacy of dialysis.

Microbiology of CAPD Infections

Understanding the microbiology of infections in CAPD is crucial; while a variety of organisms can cause peritonitis, Gram-positive bacteria, especially skin flora like Staphylococcus species, are the most common pathogens. This knowledge helps target empirical antibiotic therapy effectively until culture results are available.

Diagnostic Criteria for Peritonitis

The diagnosis of peritonitis in CAPD relies on clinical features such as abdominal pain and cloudy dialysis effluent, along with laboratory findings like an elevated leukocyte count in the peritoneal fluid. Specific thresholds (for example, counts exceeding 250 leukocytes per cubic millimeter) aid in confirming the infection, ensuring timely and appropriate management.

Catheter Management in CAPD

Proper catheter management is essential in CAPD to minimize infections. Decisions regarding catheter removal or replacement are based on the severity and recurrence of infections rather than at the early signs of peritonitis, as unnecessary changes can complicate patient management and disrupt dialysis therapy.

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