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Nephrol Dial Transplant (1992) 7: 627-631
© 1992 European Renal Association-European Dialysis and Transplant Association

research-article

Peritoneal drainage: an important element in host defence against staphylococcal peritonitis in patients on CAPD

G. R. Glancey1, J. S. Cameron and C. S. Ogg

Renal Unit, Guy's Hospital London, UK

Correspondence and offprint requests to: 1Dr Gerald Glancey, Clinical Science Laboratories, 17th Floor, Guy's Tower, Guy's Hospital, London Bridge, London SEI 9RT, UK

The growth of Staphylococcus aureus and coagulase-negative staphylococci were studied in fresh and effluent peritoneal dialysate from patients on continuous ambulatory peritoneal dialysis (CAPD). Peritoneal drainage during CAPD removes bacterial contaminants from the peritoneal cavity with an efficiency that depends upon the volume of peritoneal fluid remaining after drainage (residual volume). Combination of our data on the growth of coagulasenegative staphylococci in dialysate with a mathematical model of peritoneal drainage during CAPD shows that a residual volume of less than 800 ml (normal = {small tilde} 400 ml) will prevent survival in the peritoneal fluid. A residual volume of less than 200 ml is required to eliminate S. aureus because of its faster rate of growth in dialysate. Previous work has shown that numbers of macrophages are too few to influence bacterial growth in the peritoneal dialysate. Coagulasenegative staphylococci adhere poorly to mesothelial cells in culture. Survival within the peritoneal cavity during CAPD probably depends on colonization of the PD catheter. Coagulase-negative staphylococcal peritonitis is likely to be localized to areas of the peritoneal membrane in close contact with the PD catheter. S. aureus is able to multiply in the peritoneal dialysate during CAPD and thereby causes generalized peritonitis

Keywords: staphylococcus; bacterial growth; peritonitis; peritoneal drainage


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[Abstract] [Full Text] [PDF]


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