Outbreak of Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Population Following the Use of Contaminated Peritoneal Dialysis Fluids

Abstract

Introduction: Most cases of peritonitis during continuous ambulatory peritoneal dialysis (CAPD) are attributed to breaches of the aseptic technique. In this report, we describe an outbreak of CAPD related peritonitis that followed the use of potentially contaminated PD fluid.
Outbreak report: CAPD was introduced in the adult nephrology unit at Soba University Hospital in December 2008 with fairly satisfactory functioning and results. In June 2009, we obtained a new supply of PD fluids and started using it. Soon afterwards, a mould was found inside a new unused dialysate bag. During the following days, six patients were diagnosed to have PD related peritonitis. All patients in the unit were immediately shifted to another brand of PD fluids. Enquiry revealed that this supply of PD fluid was stored in a warm and humid environment. We surveyed the 1469 bags in the hospital stock and found another three bags (0.2%) that contained visible mould by the naked eye. The four contaminated bags contained 2.5% dextrose and were from different batches. All of them had lost the negative vacuum between the inner bag and the outer plastic envelope, but had no obvious tears in the envelope and no obvious fluid leakage. Our peritonitis rate before the outbreak was one episode in 21.7 patient-months. This sharply rose to one episode in 2.5 patient-months during the month of the outbreak, and dropped down to one episode in 17.8 patient-months in the 6-months following the outbreak.
Conclusion: Contamination of PD fluids can occur during handling and storage. Patients should meticulously examine each bag before usage. Any bag that has lost the vacuum between the inner bag and its outer envelope is potentially breached and should not be used.

Keywords: Contamination; Fungal peritonitis; Outbreak; Penicillium spp.; Peritoneal dialysis