Exit site infection due to Zygomycosis resulting in abdominal wall necrosis in a continuous ambulatory peritoneal dialysis patient

sixty-one new continuous ambulatory peritoneal dialysis (CAPD) patients were allocated to a Y connector disinfectant (Amuchina, Italy) and 63 to standard systems (Baxter Systems II & III) in a randomized clinical trial addressing peritonitis rates in 8 CAPD programs in 6 Canadian cities. In the Y connector-disinfectant group, 15 patients experienced 21 episodes of peritonitis in 452 patient-months or 1 per 21.53 patient-months. In the standard systems group, 30 patients experienced 47 episodes of peritonitis in 467 patient-months or 1 per 9.93 patient-months ( p = 0.009). The peritonitis risk reduction was 61% (95% confidence limits 27–79%). Exit-site infections occurred in 36% of each group. Prior to the development of exit -site infection, the monthly risk for peritonitis was 3.12% for the Y connector disinfectant system and 7.37% for the standard system. After an exit -site infection, these probabilities increased to 6.15% and 15.47%, respectively. Skin organisms were responsible for peritonitis in 8/21 (38%) in the Y connector-disinfectant group and 30/47 (64%) in the standard group. There were 75 days hospitalized for peritonitis in the Y connector-disinfectant group compared to 257 days for the standard group. The Y connector disinfectant system decreases the peritonitis rate through its effect on skin organisms. Exit -site infections are a major source of organisms responsible for peritonitis.

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Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site

Peritoneal Dialysis International ◽

10.1177/089686080302302s32 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 153-158 ◽

Cited By ~ 34

Author(s):

Sunny S.H. Wong ◽

Kwok Hong Chu ◽

Au Cheuk ◽

Wai Kay Tsang ◽

Samuel K.S. Fung ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Local Application ◽

Diabetic Patients ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Gram Positive ◽

Exit Site Infection ◽

Mupirocin Ointment

Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.

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Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686089001000111 ◽

1990 ◽

Vol 10 (1) ◽

pp. 41-43 ◽

Cited By ~ 42

Author(s):

John M. Burkart ◽

Britta Hylander ◽

Theresa Durnell-Figel ◽

Denise Roberts

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

First Episode ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Significant Difference ◽

Stage Renal Disease ◽

The Impact

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

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Natural History of Exit-Site Infection (ESI) in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088800800308 ◽

1988 ◽

Vol 8 (3) ◽

pp. 211-216 ◽

Cited By ~ 69

Author(s):

Georgi Abraham ◽

Evgeije Savin ◽

Anthony Ayiomamitis ◽

Sharron Izatt ◽

Stephen I. Vas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Staph Aureus ◽

Serous Discharge ◽

History Of ◽

One Year ◽

Esi Group

One hundred and thirty-one patients were started on continuous ambulatory peritoneal dialysis (CAPD) between January 1984 and June 1987. They ranged in age from 14 to 82 years (mean 52.8). Sixty patients (1914 patient months) developed 133 episodes of exit-site infection (ESI), an incidence of one episode per 14.4 patient months. Sixty-six episodes were purulent and 67 were nonpurulent (redness, crust, or serous discharge). In diminishing order of frequency, the bacteria isolated were Staph. aureus, Staph. epidermidis, Pseudomonas, and diphtheroids. The probability for remaining free of ESI was 54% at one year and 22% at three years. Factors like single or double-cuff catheters, diabetes, and sex did not influence the development of ESI. Recurrence was common especially in purulent ESI, and medical or surgical treatment did not eradicate the infection. Patients with purulent ESI had a higher incidence of peritonitis than those with no ESI-one episode per 8.1 patient months vs. one episode per 20.9 patient months. In the ESI group, of the 154 catheters implanted, 24 (15.6%) were removed; five were lost without ESI (3%). The main cause leading to catheter removal in the ESI group were Staph. aureus and Pseudomonas infections. Peritonitis following ESI was not necessarily due to the organisms isolated from the ESI.

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