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Aim: To evaluate current practice and barriers to the uptake of clinical practice guidelines on the prophylactic use of antibiotic and antifungal agents in peritoneal dialysis (PD) patients.

Background: Guidelines exist which outline antimicrobial measures to prevent the development of PD-related infections. Rates of these infections vary widely across Australian and New Zealand PD units, with multiple units reporting suboptimal rates. PD technique survival rates are lower than those achieved elsewhere. Deviations from current clinical practice guidelines may contribute to these poorer outcomes.

Methods: Multicentre study involving eight PD units, using mixed methods of qualitative and quantitative analysis. Current management processes around three guideline recommendations were assessed by on-site interview. Data on PD-related infection rates were collected prospectively over a 6.5 month period between 12 December 2011 and 30 June 2012.

Results: The infection definitions used by some units varied from accepted ISPD definitions, particularly with exit site infection (ESI). The rates of ESI and peritonitis varied widely between units, ranging from 1 in 22 patient-months (pm) to 1 in 212 pm and from 1 in 14 to 1 in 39 pm, respectively. There is the potential for under-reporting at some units. Barriers to adherence to guideline recommendations included lack of knowledge, procedural lapses, no centralised patient database, patient with non-English speaking background, professional concern about antibiotic resistance, medication cost and the inability of hospital staff to reach consensus on unit protocols.

Conclusions: Despite the existence of …