Clinical and Genetic Analysis of Staphylococcus aureus Nasal Colonisation and Exit-Site Infection in Patients Undergoing Peritoneal Dialysis

2001 ◽  
Vol 20 (10) ◽  
pp. 734-737 ◽  
Author(s):  
B. Kreft ◽  
S. Eckstein ◽  
A. Kahl ◽  
U. Frei ◽  
W. Witte ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Genetic Analysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection

Staphylococcus Aureus Prophylaxis and Trends in Gram-Negative Infections in Peritoneal Dialysis Patients

2003 ◽  
Vol 23 (5) ◽  
pp. 456-459 ◽  
Author(s):  
Beth Piraino ◽  
Judith Bernardini ◽  
Tracey Florio ◽  
Linda Fried
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Time Period ◽  
Before And After ◽  
Year 2000

Objective To examine gram-negative exit-site infection and peritonitis rates before and after the implementation of Staphylococcus aureus prophylaxis in peritoneal dialysis (PD) patients. Design Prospective data collection with periodic implementation of protocols to decrease infection rates in two PD programs. Patients 663 incident patients on PD. Interventions Implementation of S. aureus prophylaxis, beginning in 1990. Main Outcome Measures Rates of S. aureus, gram-negative, and Pseudomonas aeruginosa exit-site infections and peritonitis. Results Staphylococcus aureus exit-site infection and peritonitis rates fluctuated without significant trends during the first decade (without prophylaxis), then began to decline during the 1990s subsequent to implementation of prophylaxis, reaching levels of 0.02/year at risk and zero in the year 2000. Gram-negative infections fell toward the end of the 1980s, due probably to the implementation of better connectology. However, there have been no significant changes for the past 6 years. There was little change in P. aeruginosa infections over the entire time period. Pseudomonas aeruginosa is now the most common cause of catheter infection and catheter-related peritonitis. Conclusions Prophylaxis against S. aureus is highly effective in reducing the rate of S. aureus infections but has no effect on gram-negative infections. Pseudomonas aeruginosa is now the most serious cause of catheter-related peritonitis.

Emergence of Mupirocin-Resistant Staphylococcus Aureus in Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection

2001 ◽  
Vol 21 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Rajeev Annigeri ◽  
John Conly ◽  
Stephen I. Vas ◽  
Helen Dedier ◽  
Kannam P. Prakashan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Total Study Population ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Mannitol Salt Agar ◽  
High Level

Objective To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. Methods Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. Results Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. Conclusion We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

Toxic Shock Syndrome With Staphylococcus aureus Exit-Site Infection in a Patient on Peritoneal Dialysis

1990 ◽  
Vol 15 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Joseph R. Sherbotie ◽  
Karen Polise ◽  
Andrew Costarino ◽  
Joseph V. DiCarlo ◽  
Bernard S. Kaplan
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Toxic Shock Syndrome ◽  
Site Infection ◽  
Toxic Shock ◽  
Exit Site ◽  
Exit Site Infection

Repeat Peritoneal Dialysis Exit-Site Infection: Definition and Outcomes

2019 ◽  
Vol 39 (4) ◽  
pp. 344-349 ◽  
Author(s):  
Hannah Beckwith ◽  
Michelle Clemenger ◽  
Jacqueline McGrory ◽  
Nora Hisole ◽  
Titus Chelapurath ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Dialysis Modality ◽  
Site Infection ◽  
Exit Site ◽  
Retrospective Case ◽  
Exit Site Infection ◽  
Catheter Exchange ◽  
Number Of Patients

BackgroundThe most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.MethodsRetrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.ResultsOverall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus ( n = 16, 52%) and Pseudomonas aeruginosa ( n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).ConclusionWe have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.

Toxic Shock Syndrome in Two CAPD Patients with Staphylococcus Aureus Exit-Site Infection

2003 ◽  
Vol 23 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Mehmet R. Altiparmak ◽  
Hande Demirel ◽  
Ali Mert ◽  
Kamil Serdengecti ◽  
Rezzan Ataman
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Toxic Shock Syndrome ◽  
Case Definition ◽  
Peritoneal Dialysis Catheter ◽  
Site Infection ◽  
Toxic Shock ◽  
Exit Site ◽  
Exit Site Infection ◽  
Cutaneous Infections

Toxic shock syndrome (TSS) is an illness defined by the occurrence of fever, rash, hypotension, multiple organ system dysfunction, and desquamation. Nonmenstrual TSS is often associated with surgical or nonsurgical cutaneous infections, which are rarely purulent or inflamed (Reingold AL, et al. Nonmenstrual toxic shock syndrome: a review of 130 cases. Ann Intern Med 1982; 96:871–4). Toxic shock syndrome associated with peritoneal exit-site infection but without peritonitis is extremely unusual (Sherbotie JR, et al. Toxic shock syndrome with Staphylococcus aureus exit-site infection in a patient on peritoneal dialysis. Am J Kidney Dis 1990; 15:80–3). We describe 2 patients that met the Centers for Disease Control case definition of TSS secondary to a peritoneal dialysis catheter exit-site infection with signs of mild inflammation and growth of Staphylococcus aureus, but with no evidence of peritonitis.

scholarly journals Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

1996 ◽  
Vol 7 (11) ◽  
pp. 2403-2408
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Treatment Group ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

Staphylococcus Aureus Peritonitis is Associated with Staphylococcus Aureus Nasal Carriage in Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 232-335 ◽  
Author(s):  
Beth Piraino ◽  
Jeffrey A. Perlmutter ◽  
Jean L. Holley ◽  
Judith Bernardini
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Site Infection ◽  
Dialysis Patients ◽  
Exit Site ◽  
Exit Site Infection ◽  
Increased Risk ◽  
Definition Of ◽  
The Relationship

Although the definition of S. aureus nasal carriage in peritoneal dialysis patients Is variable, carriage is often defined as 2 or more positive cultures for S. aureus. We Investigated the relationship between S. aureus Infections and nasal carriage (defined as 1 or more positive nose cultures) In 138 patients on peritoneal dialysis. By this definition, approximately 50% of the patients were carriers. The rates of S. aureus exit-site infection (0.28/year vs 0.43/year, p<0.001) and peritonitis (0.08/year vs 0.20/year, p<0.001) were lower in the noncarriers (patients with no positive nose cultures) than in those patients who had 1 or more positive nose cultures. Patients with only 1 positive nose culture had a similar S. aureus exit-site infection rate (0.31/year vs 0.28/year), but a higher peritonitis rate (0.24/year vs 0.08/year, p<0.001) compared to those petients with no positive nose cultures. However, patients with 2 or more positive nose cultures were at Increased risk for both S. aureus exit-site Infections and peritonitis. This relationship held even when only petients with frequent nose cultures were Included In the analysis. Thus patients with even 1 positive nose culture for S. aureus are at risk for S. aureus peritonitis and should not be classified as noncarriers.

scholarly journals Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edyta Gołembiewska ◽  
Kazimierz Ciechanowski
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Polycythemia Vera ◽  
Significant Risk ◽  
Renal Amyloidosis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
First Case

Abstract Background Infectious complications of peritoneal dialysis (PD) remain a common cause of catheter loss and discontinuation of PD. Exit site infection (ESI) constitutes a significant risk factor for PD-related peritonitis and determination of predisposing states is relevant. We here present a case of repeat ESI due to Pseudomonas aeruginosa in a PD patient with skin changes in the course of polycythemia vera (PV). Case presentation A 73-year-old PD patient with chronic kidney disease secondary to renal amyloidosis and ankylosing spondylitis, presented to the nephrology unit with signs of ESI. In 2006 he was diagnosed with PV and since then has was successfully treated with hydroxyurea; however, he reported recurrent episodes of developing skin nodules in the course of the disease. Exit site swab yielded Pseudomonas aeruginosa and the infection developed in the ulcerated PV nodule that appeared in exit site 2 weeks earlier. Patient was treated with intraperitoneal amikacin and oral ciprofloxacin, however, due to neurological complications, the treatment had to be interrupted and finally catheter was removed. Similar episode of ESI with Pseudomonas aeruginosa developed in the patient two years earlier and also required catheter removal. Conclusion This is the first case report demonstrating the development of ESI on the polycythemia vera skin lesion in this area. Skin manifestations of PV might be a predisposing factor to ESI in PD patients.

Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children

1990 ◽  
Vol 10 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Maurice Levy ◽  
J. Williamson Balfe ◽  
Dennis Geary ◽  
Sue Fryer-Keene ◽  
Robert Bannatyne
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Daily Dialysis ◽  
Pseudomonas Species ◽  
Before And After ◽  
Species Being ◽  
Catheter Replacement

A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gramnegative organisms were responsible for 23 ESls, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.

Sign in / Sign up

Export Citation Format

Share Document