Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Objectives To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS). Design From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion. Results The ages of the 6 boys ranged from 10 months 17 years. The dialysis duration was from 9–22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery. Conclusion Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.

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The Honeypot Study Protocol: A Randomized Controlled Trial of Exit-Site Application of Medihoney Antibacterial Wound Gel for the Prevention of Catheter-Associated Infections in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080902900315 ◽

2009 ◽

Vol 29 (3) ◽

pp. 303-309 ◽

Cited By ~ 19

Author(s):

David W. Johnson ◽

Carolyn Clark ◽

Nicole M. Isbel ◽

Carmel M. Hawley ◽

Elaine Beller ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Peritoneal Dialysis ◽

New Zealand ◽

Controlled Trial ◽

Nasal Carriage ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Randomized Controlled ◽

Tunnel Infection

Objectives The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers. Design Multicenter, prospective, open label, randomized controlled trial. Setting PD units throughout Australia and New Zealand. Participants The study will include both incident and prevalent PD patients (adults and children) for whom informed consent can be provided. Patients will be excluded if they have had ( 1 ) a history of psychological illness or condition that interferes with their ability to understand or comply with the requirements of the study; ( 2 ) recent (within 1 month) exit-site infection, peritonitis, or tunnel infection; ( 3 ) known hypersensitivity to, or intolerance of, honey or mupirocin; ( 4 ) current or recent (within 4 weeks) treatment with an antibiotic administered by any route; or ( 5 ) nasal carriage of mupirocin-resistant Staphylococcus aureus. Methods 370 subjects will be randomized 1:1 to receive either daily topical exit-site application of Medihoney Antibacterial Wound Gel (all patients) or nasal application of mupirocin if staphylococcal nasal carriage is demonstrated. All patients in the control and intervention groups will perform their usual exit-site care according to local practice. The study will continue until 12 months after the last patient is recruited (anticipated recruitment time is 24 months). Main Outcome Measures The primary outcome measure will be time to first episode of exit-site infection, tunnel infection, or peritonitis, whichever comes first. Secondary outcome measures will include time to first exit-site infection, time to first tunnel infection, time to first peritonitis, time to infection-associated catheter removal, catheter-associated infection rates, causative organisms, incidence of mupirocin-resistant microbial isolates, and other adverse reactions. Conclusions This multicenter Australian and New Zealand study has been designed to provide evidence to help nephrologists and their PD patients determine the optimal strategy for preventing PD catheter-associated infections. Demonstration of a significant improvement in PD catheter-associated infections with topical Medihoney will provide clinicians with an important new prophylactic strategy with a low propensity for promoting antimicrobial resistance.

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The Association between Exit Site Infection and Subsequent Peritonitis among Peritoneal Dialysis Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.00980112 ◽

2012 ◽

Vol 7 (8) ◽

pp. 1266-1271 ◽

Cited By ~ 51

Author(s):

Anouk T.N. van Diepen ◽

George A. Tomlinson ◽

Sarbjit V. Jassal

Keyword(s):

Peritoneal Dialysis ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s140894 ◽

2017 ◽

Vol Volume 13 ◽

pp. 909-914 ◽

Cited By ~ 1

Author(s):

Oguzhan Dizdar ◽

Ozerhan Ozer ◽

Selahattin Erdem ◽

Ali Ihsan Gunal

Keyword(s):

Peritoneal Dialysis ◽

Pilot Study ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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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 exit site infection and peritonitis incidences between povidone-iodine and normal saline use for chronic exit site care in peritoneal dialysis patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2014.05.030 ◽

2014 ◽

Vol 33 (3) ◽

pp. 144-149 ◽

Cited By ~ 7

Author(s):

Su Mi Lee ◽

Hwa Seong Nam ◽

Eu Gene Jeong ◽

Young Ki Son ◽

Seong Eun Kim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Normal Saline ◽

Povidone Iodine ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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Pseudomonas exit site infections in continuous ambulatory peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v2101498 ◽

1992 ◽

Vol 2 (10) ◽

pp. 1498-1501

Author(s):

H R Kazmi ◽

F D Raffone ◽

A S Kliger ◽

F O Finkelstein

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Catheter Removal ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection ◽

Retrospective View ◽

History Of ◽

Oral Ciprofloxacin

The purpose of this study is to examine the natural history of Pseudomonas aeruginosa exit site infections in continuous ambulatory peritoneal dialysis (CAPD) patients treated with oral ciprofloxacin and local exit site care. A retrospective view was undertaken of 18 episodes of P. aeruginosa exit site infections developing in 17 patients maintained on CAPD during 1989 and 1990. Standardized therapy for the exit site infection consisted of oral ciprofloxacin (500 mg twice daily) and local exit site care with antiseptic agents. Fifteen (83%) of 18 of the pseudomonas exit site infections resolved with therapy. Three episodes (17%) required catheter removal to successfully eradicate the infection. Four of the 15 patients whose exit site infections resolved developed P. aeruginosa peritonitis 2 to 9 months after the clinical resolution of the exit site infection. The majority of pseudomonas exit site infections in CAPD patients can be successfully treated with oral ciprofloxacin and local care. Approximately 17% of the patients in this study required catheter removal to successfully eradicate the infection and an additional 22% of the patients developed pseudomonas peritonitis several months after the resolution of the exit site infection.

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