Biomedical subjects

P Tofte-Jensen

Publications and source records attributed to P Tofte-Jensen.

4 recordsLinked to original sources

PubMed1996

Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID).

A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.

Carrier State↗

PubMed1994

Peritonitis incidence on a disconnect CAPD-system with or without the use of iodine clamp shields.

The purpose of the study was to review a single center's experience with the disconnect system for continuous ambulatory peritoneal dialysis (CAPD), and to evaluate peritonitis incidence with and without use of iodine-containing clamp shields. The retrospective review of patients using the disconnect system lasted from January 1991 throughout March 1993, evaluating the peritonitis incidence with and without use of iodine clamp shields. In the observation period, a total of 103 patients were evaluated. Of these, 42 patients were treated with iodine clamp shields until July 1992 and then were instructed not to use the iodine clamp shields, thus acting as their own controls. We found an overall peritonitis incidence of 0.411 episodes/patient/year (= 29.2 patient-months/episode) on disconnect CAPD-system (Baxter), in spite of the fact that more than 60% of our dialysis population is treated with peritoneal dialysis. We found no difference in peritonitis rates with or without the use of iodine clamp shields. Peritonitis rates with clamp shields were 0.400 episodes/patient/year and, without clamp shields, were 0.400 episodes/patient/year. The introduction of a disconnect system provided a system with low incidence of peritonitis. No difference in peritonitis rates was observed with or without the use of iodine clamp shields, allowing us to reduce the cost of treatment and to simplify training procedures.

Adult↗

PubMed1994

PD-related infections of standard and different disconnect systems.

A review of 332 patients initiating continuous ambulatory peritoneal dialysis (CAPD) treatment from January 1988 throughout September 1993, with a total observation time of 5237 patient-months. Seven peritoneal dialysis (PD) systems were used, three of which were comparable regarding patient characteristics: standard system (Baxter) and two disconnect systems, Twinbag (Baxter) and Gemini (Gambro). The two disconnect systems were identical in principle, except that Twinbag used iodine as disinfectant of connections and Gemini used alcohol as disinfectant. We found a reduction of peritonitis rates in one of the disconnect systems--Twinbag (iodine) 0.42 episodes/patient/year--and a slight increase in another disconnect system--Gemini (alcohol) 1.17 epi/patient/yr--compared to standard system (iodine) 0.92 epi/patient/yr. An improvement of exit-site infections (ESI) and tunnel infections was seen in both disconnect systems (0.17 and 0.20 epi/patient/yr) compared to standard system (0.35 epi/patient/yr). Introduction of disconnect CAPD system reduced peritonitis rates in systems using iodine as disinfectant. Disconnect systems reduced ESI, probably due to less trauma to the catheter. We recommend the use of disconnect CAPD systems using iodine instead of alcohol as disinfectant.

Disinfectants↗

PubMedDate not supplied

A prospective, randomized multicenter study comparing APD and CAPD treatment.

OBJECTIVE: The goals for maintenance dialysis treatment are to improve patient survival, reduce patient morbidity, and improve patient quality of life. This is the first randomized prospective study comparing automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) treatment with respect to quality of life and clinical outcomes in relation to therapy costs. DESIGN: A prospective, randomized multicenter study. SETTING: Three Danish CAPD units. PATIENTS: Thirty-four adequately dialyzed patients with high or high-average peritoneal transport characteristics were included in the study.Twenty-five patients completed the study. INTERVENTIONS: After randomization, 17 patients were allocated to APD treatment and 17 patients to CAPD treatment for a period of 6 months. Medical and biochemical parameters were evaluated at monthly controls in the CAPD units. Quality-of-life parameters were assessed at baseline and after 6 months by the self-administered short-form SF-36 generic health survey questionnaire supplemented with disease- and treatment-specific questions. Therapy costs were compared by evaluating dialysis-related expenses. MAIN OUTCOME MEASURES: Quality-of-life parameters, dialysis-related complications, dialysis-related expenses. RESULTS: The quality-of-life studies showed that significantly more time for work, family, and social activities was available to patients on APD compared to those on CAPD (p < 0.001). Although the difference was not significant, there was a tendency for less physical and emotional discomfort caused by dialysis fluid in the APD group. Sleep problems, on the other hand, tended to be more marked in the APD group. Any positive effect of APD compared to CAPD on dialysis-related hospital days or complication rates could not be confirmed. With larger patient samples, it is possible, however, that a significant difference might have been achieved. The running costs for APD treatment were US $75 per day and for CAPD treatment US $61 per day. CONCLUSION: If APD treatment can help to keep selected patients vocationally or socially active, paying the extra cost seems reasonable.

Denmark↗