Impact of new connectology in reducing peritonitis

A computer initiated literature search for publications addressing the association between connectology and peritonitis in continuous peritoneal dialysis patients identified 23 relevant articles. These publications used one of four basic clinical research designs (before-after; single centre prospective cohort; multi-centre prospective cohort and randomized clinical trial). The methodologic weaknesses inherent in the first two designs significantly impaired the validity of their conclusions. The two multi-centre cohort studies and the five randomized clinical trials have external and internal validity, respectively. Combined, they suggest that the Y connector-disinfectant system and the twin bag systems are associated with less peritonitis than standard, ultraviolet and possibly the Y set without disinfectant. The effect is entirely due to decreased infection with Staphylococcus epidermidis and other organisms associated with touch contamination. Peritonitis due to these organisms does not cause significant loss of peritoneal dialysis catheters or transfer to haemodialysis. The decreased hospitalization due to fewer episodes of peritonitis will become less important with more outpatient antibiotic treatment of these mild infections. Significant improvement in the morbidity associated with peritoneal dialysis related infection will require effective strategies for prevention of infection due to Staphylococcus aureus and gram-negative organisms.