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Reply to De Vecchi and Scalamogna

Editor: Contrary to Drs. De Vecchi and Scalamogna’s understanding, our paper suggested there was no difference in the probability of developing the first episode of peritonitis without a mask (1). Their data refer only to patients who developed peritonitis. It is possible that patients disregarding some training instructions (such as wearing a face mask) overlook other preventive measures (such as hand-washing). It would be interesting to know the percentage of individuals that, either occasionally or systematically, did not wear a face mask and did not develop peritonitis. The design used in our study was a two-phase cohort, a controlled, although not concurrent study. It was thought that simultaneous evaluation of the two groups could result in an exchange of experiences among participants sharing the same waiting room. Patients and assistants in the group “with mask” were instructed to wear a face mask (see Methods in our paper). One single case of streptococcal infection among 107 episodes of peritonitis does not seem to point to a “protective role” for face masks. Patients and assistants were instructed not to talk while performing system disconnection. Data on compliance of different populations on continuous ambulatory peritoneal dialysis (CAPD) are unavailable but, possibly, Brazilian and Italian patients do not differ regarding frequency of mouth opening during bag exchange. It has long been known that S aphylococcus aureus nasal carriers are also skin carriers. Bacteria may be transferred from hands to exit site and CAPD tubing (so far, no preventive role for the face mask). The face mask may be a source of bacterial contamination (2), and conflict between surgical tradition and evidence surrounds its use. Several trials have suggested no difference in prevalence of wound infection, wearing or not wearing a face mask, in different settings (3). The same reasoning may apply to CAPD bag exchange. Our study reports the experience of a single center — hence with a restricted number of patients — but provides the only available evidence on the use of a face mask and prevention of CAPD peritonitis.