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.

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.

Tenckhoff Catheter Repair by the Splicing Technique

1984 ◽  
Vol 4 (2) ◽  
pp. 89-91 ◽  
Author(s):  
Jorge Roman ◽  
Alexandro R. Gonzalez
Keyword(s):  
Peritoneal Dialysis ◽  
Simple Technique ◽  
Partial Replacement ◽  
Chronic Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Outpatient Procedure ◽  
Catheter Replacement ◽  
Catheter Segment

One of the main complications of the double-cuffed chronic peritoneal dialysis catheters is cuff erosion, with or without exit-site infection. We present a simple technique, which allows partial replacement of the external catheter segment with splicing. In addition it can be used to replace the intraperitoneal segment, leaving undisturbed the external segment and exit site. This technique can be carried out under local anesthesia, as an outpatient procedure, without interrupting treatment and with less trauma than total catheter replacement. This paper describes our experience with 20 external catheter replacements in 17 patients followed up to 20 months.

Comparison of Exit -Site Infections in Disconnect versus Nondisconnect Systems for Peritoneal Dialysis

1992 ◽  
Vol 12 (3) ◽  
pp. 317-320 ◽  
Author(s):  
John M. Burkart ◽  
Jean R. Jordan ◽  
Theresa A. Durnel ◽  
L. Douglas Case
Keyword(s):  
Peritoneal Dialysis ◽  
Marked Reduction ◽  
Site Infection ◽  
Automated Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Endstage Renal Disease ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Private Setting

Objective To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems. Design We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Yset, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)). Setting A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting. Patients All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of endstage renal disease (ESRD) or age. Intervention Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care. Main Outcome We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections. Results Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p=0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit -site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62, spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD). Conclusion We found no overall difference in exit site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.

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

Influence of Climate on the Incidence of Peritoneal Dialysis-Related Peritonitis

2003 ◽  
Vol 23 (6) ◽  
pp. 580-586 ◽  
Author(s):  
Cheuk-Chun Szeto ◽  
Kai-Ming Chow ◽  
Teresa Yuk-Hwa Wong ◽  
Chi-Bon Leung ◽  
Philip Kam-Tao Li
Keyword(s):  
Peritoneal Dialysis ◽  
Seasonal Variation ◽  
Odds Ratio ◽  
Site Infection ◽  
Exit Site ◽  
Chi Square ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Significant Seasonal Variation ◽  
Chi Square Test

Objective The use of peritoneal dialysis has expanded in many developing subtropical countries; however, the role of climatic factors in dialysis-related peritonitis has not been studied in detail. Design Retrospective study. Setting A single regional dialysis unit in a university teaching hospital. Patients We reviewed all cases of dialysis-related peritonitis treated in our dialysis unit from January 1995 to December 2001. Information was collected on demographic data, microbiologic etiology, associated catheter exit-site infection, and clinical response. Results In 24 059 patient-months of follow-up, 1344 episodes of peritonitis were recorded. There were significantly more peritonitis episodes in July and August [odds ratio 1.17, 95% confidence interval (CI) 1.03 – 1.32], and fewer peritonitis episodes in December (odds ratio 0.79, 95% CI 0.61 – 0.98). There was also a trend of more peritonitis in March (odds ratio 1.18, 95% CI 0.97 – 1.41), but the difference was not statistically significant. When the incidence of peritonitis caused by individual bacterial species was further analyzed, we found a significant seasonal variation in the rate of peritonitis caused by gram-negative bacteria, except Pseudomonas (overall chi-square test, p = 0.002). A similar trend of seasonal variation was also observed in gram-positive peritonitis, but the result was not statistically significant. There was significant seasonal variation in the rate of peritonitis that had coexisting exit-site infection (overall chi-square test, p = 0.02), with peak incidence in July. However, the proportion of peritonitis that had coexisting exit-site infection did not have significant seasonal variation. There was significant correlation between monthly peritonitis rate and average humidity ( r = –0.346, p < 0.002) and temperature ( r = –0.264, p = 0.015). Conclusions There is substantial seasonal variation in the incidence of dialysis-related peritonitis, with peak incidence in the months that are hot and humid. Keeping a cool and dry living environment may help to reduce peritonitis in peritoneal dialysis patients in tropical countries.

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.

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