Abstract

All dialysis treatments include a certain risk of infection because of the decreased immune defenses of the patients and because of dialytic techniques that increase the potential of microbial contamination. Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a higher risk of infections of the peritoneum, but even of the subcutaneous tunnel. These infections are caused by environmental microorganisms principally gram-positives (Staphylococcus epidermidis and Staphylococcus aureus). We tested three active ingredients, electrolytic chloroxidizer, iodine and chlorhexidine gluconate. It is evident that because of the large spectrum of activity, the good effectiveness even at the lowest concentration, coupled with good tolerability (and to the fact of not causing allergic reactions) the electrolytic chloroxidizer appears to be an ideal antiseptic in CAPD.

Copyright © 2007 S. Karger AG, Basel

All dialysis treatments include a certain risk of infection because of the decreased immune defenses of the patients and because of dialytic techniques that increase the potential of microbial contamination.

Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a higher risk of infections of the peritoneum, but even of the subcutaneous tunnel. These infections are caused by environmental microorganisms, principally gram-positives (Staphylococcus epidermidis and Staphylococcus aureus).

Contamination of the infection sites (tunnel and peritoneal cavity) is favored by the interruption of the abdominal wall continuity, by the presence of the catheter, and by the introduction of the dialysate. The following possible affection is clearly favored by the patient conditions (uremia, malnutrition, etc.), but also:

• in case of the tunnel infection, by the continuous presence of the catheter, and

• in the case of peritonitis, by the large number of catheter-solution bag connection operations (opening and closing).

In order to reduce these complications that could require clinical intervention and could significantly limit the patient survival and the technique success, the prevention of the contamination and the destruction of the microorganisms, before entering the peritoneal cavity, are crucial.

In hemodialysis the microbial contamination can directly involve the patient (access site infections) and the extracorporeal circuit. There is the possibility to transmit even viruses to the patient or, more frequently, endotoxins through the dialysis membranes.

Many systems have been proposed to achieve the destruction of the microbial contaminants: (1) physical such as heat, UV radiation, etc., and (2) chemical. For use in PD antiseptics are favored, and not disinfectants, because disinfectants can be used on inanimate objects only and not on living tissues or with uses that could even indirectly put them in contact with living tissue.

In any case, the physical agents did not achieve a good success because of difficult practical use, more expensive or not effective. Better interest has been reserved to chemicals.

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