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Infectious complications are the leading cause of morbidity and mortality in peritoneal dialysis (PD) patients. Infectious diseases play a role in the morbidity and mortality of hemodialysis (HD) patients as well. Prevention of transmission of infectious diseases is of paramount importance in any program concentrating on renal replacement therapy, including HD, PD and kidney transplantation. Despite effective means to eradicate infections, increased usage of antimicrobial agents has resulted in antimicrobial resistance. The focus of this paper will be infections in dialysis. Some of the infectious complications discussed here may be applicable to patients with end-stage renal disease who have received a kidney transplant. Prevention of infections in dialysis includes development of infection control strategies by dialysis units with appropriate surveillance strategies. Dialysis staff education, patient education and physician participation is essential for successful infection control in dialysis units. Patients with other chronic infections, such as hepatitis B and human immunodeficiency virus (HIV) infection on dialysis may require additional infection control strategies for dialysis units to prevent infection of other patients and dialysis unit staff. Surveillance and prevention of tuberculosis is part of the comprehensive infection control plan for patients and staff and special considerations may occur for treatment of tuberculosis in other epidemiologic and economic areas of the world. Immunizations, a cornerstone to prevent many infections, have led to decreased morbidity and mortality for many diseases and many immunizations play a role in prevention of disease in dialysis patients.

We report four episodes of non Candida albicans peritonitis (NCAP) in 3 patients on continuous ambulatory peritoneal dialysis (CAPD). Risk factors for NCAP included diabetes mellitus and prior antibiotic use in half of the cases. The antibiotic treatment was prescribed for exit-site infection (ESI) or peritonitis in the patient. Treatment for NCAP included antifungal therapy with oral fluconazole or intravenous amphotericin B. The NCAP resulted in catheter loss in 100% of the patients over time. Initial catheter salvage in one patient was followed 6 months later by catheter loss following treatment of a bacterial peritonitis that was complicated by the development of Candida (Torulopsis) glabrata peritonitis unresponsive to treatment with intravenous amphotericin B. Although the literature suggests that Candida peritonitis responds to oral fluconazole with and without catheter removal, this series suggests that the treatment of NCAP includes removal of the peritoneal dialysis catheter with appropriate antifungal agents.

Only 15 cases of any etiology of Neisseria meningitidis peritonitis have been reported in the world literature since the first case in 1917. We report the first case in a continuous ambulatory peritoneal dialysis (CAPD) patient presenting with abdominal pain and cloudy peritoneal dialysis fluid. A lumbar puncture was normal. The patient died despite therapy with ceftriaxone. Autopsy confirmed this was a case of primary N. meningitidis peritonitis. Of the 15 cases of N. meningitidis reported as a cause of peritonitis, 9 patients were less than age 35 with no underlying diseases. Five cases were associated with cirrhosis or alcohol abuse. Two cases were associated with meningitis, and 1 patient was on steroid therapy for systemic lupus erythematosus. Nine of 15 patients recovered. In conclusion, N. meningitidis should be considered as another rare cause of peritonitis in patients on CAPD.