Exit-Site Infection in Children on Peritoneal Dialysis: Comparison of Two Types of Peritoneal Catheters

2003 ◽  
Vol 23 (2) ◽  
pp. 169-173 ◽  
Author(s):  
Stanislaw Warchol ◽  
Helena Ziolkowska ◽  
Maria Roszkowska–Blaim
Keyword(s):  
Clinical Investigation ◽  
Statistical Significance ◽  
Observation Time ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Large Numbers ◽  
The Mean ◽  
End Stage ◽  
Medical University

Objective To review our experience with two types of peritoneal catheters, the standard Tenckhoff catheter and the swan-neck presternal catheter (SNPC). Design A retrospective study was undertaken to compare exit-site infection (ESI) rates using two types of peritoneal catheters in children. Setting Medical University of Warsaw, Warsaw, Poland. Patients During the past 10 years, 60 peritoneal catheters were implanted in 50 children with end-stage renal failure: 46 straight, double-cuffed Tenckhoff in 37 children (mean age 11.8 ± 4.2 years, range 3.1 – 18.5 years), and 14 presternal in 13 children (mean age 10.6 ± 5 years, range 0.3 – 17.7 years). The SNPCs were used in special clinical situations such as recurrent ESI with previous abdominal peritoneal catheters, obesity, presence of ureterocutaneostomies, use of diapers, and young age. For the statistical analysis, only the first catheter placed in each child was chosen: 34 standard Tenckhoff catheters and 9 SNPCs. Intervention In all children, peritoneal catheters were implanted surgically under general anesthesia by one surgeon; uniform operative technique and perioperative management was used. Results The mean observation time for 46 standard Tenckhoff catheters was 23.8 ± 21.1 months, and for 14 SNPCs 25.1 ± 27.0 months. The ESI rate was 1/17.4 patient-months (0.69 episodes/year) for Tenckhoff catheters and 1/70.2 patient-months (0.17 episodes/year) for SNPCs. The observed differences in ESI rates between the groups reported did not achieve statistical significance. Conclusions The risk of ESI may be lower with presternal catheters. Confirmation of these findings requires further prospective clinical investigation in large numbers of patients.

Exit-site Infections by Non-diphtheria Corynebacteria in Capd

2004 ◽  
Vol 24 (5) ◽  
pp. 454-459 ◽  
Author(s):  
Helmut Schiffl ◽  
Claudia Mücke ◽  
Susanne M. Lang
Keyword(s):  
Site Infection ◽  
Exit Site ◽  
Oral Cephalosporin ◽  
Exit Site Infection ◽  
Corynebacterium Species ◽  
Corynebacterium Striatum ◽  
Biochemical Identification ◽  
Stage Renal Disease ◽  
End Stage ◽  
Observation Period

Non-diphtheria corynebacteria species cause disease in risk populations such as immunocompromised patients and patients with indwelling medical devices. Despite reports of exit-site infection and peritonitis caused by non-diphtheria corynebacteria, these organisms are frequently dismissed as contaminants. During a 10-year observation period, we prospectively identified 8 cases of exit-site/tunnel infections caused by 2 different species of corynebacteria ( Corynebacterium striatum in 5 and C. jeikeium in 3 cases). Four patients experienced a second episode of exit-site infection 3 months (2 cases), 25 months, and 40 months, respectively, after termination of an oral cephalosporin therapy of 4 to 6 weeks’ duration. Non-diphtheria corynebacteria accounted for 9% of all exit-site infections during the study period. All catheter-related infections healed; no catheter had to be removed. The diagnosis of catheter-related non-diphtheria corynebacteria infection may be suspected when Gram stain shows gram-positive rods and with colony morphology and commercial biochemical identification systems. Susceptibility of non-diphtheria corynebacteria to antibiotics may vary, especially in C. jeikeium. Virtually all Corynebacterium species are sensitive to vancomycin. Empirical antibiotic therapy with vancomycin should be initiated while antibiotic susceptibility testing is being carried out. Oral cephalosporin may be an alternative treatment regimen for exit-site infections if sensitive. This study highlights the importance of non-diphtheria corynebacteria as emerging nosocomial pathogens in the population of end-stage renal disease patients on on continuous ambulatory peritoneal dialysis.

Comparisons of Y-Set Disconnect System (Ultraset) versus Conventional Spike System in Uremic Patients on Capd: Outcome and Cost Analysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 368-370 ◽  
Author(s):  
Philip Kam Tao Li ◽  
Tak Hin Chan ◽  
Wing Yee So ◽  
Angela Y.M. Wang ◽  
Chi Bon Leung ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Randomized Study ◽  
Hospitalization Rate ◽  
Exit Site ◽  
Exit Site Infection ◽  
Fungal Peritonitis ◽  
The Mean ◽  
End Stage ◽  
Hospital Days ◽  
Single Blind

We conducted a single-blind, prospective randomized study on the use of the V -set disconnect system (Uttraset) (U) versus the conventional (C) spike system to assess the peritonitis rate, exit-site infection (ESt), clinical outcome, the resulting hospitalization rate, and recurrent costs. Forty new end-stage renal failure patients admitted to the dialysis program were recruited into the study and 20 each were randomly allocated to the U and C systems. They were studied for a period of 12 months. The mean number of days required to train patients for the U and C systems were 8.6 and 9.8 days, respectively. The peritonitis rates for the U and C systems were one episode every 17 and 11.4 patient-months, respectively. The ESI rates for the U and C systems were one episode every 26.4 and 21.6 patient-months, respectively. Four catheters were removed due to fungal peritonitis (three with the C system and one with the U system). As related to peritonitis, patients on the C system required 57 hospital-days while those on the U system required 28 days per year. On cost analysis, the extra cost required for the U system can be offset by the other expenses incurred for events related to more infections on the C system. It is concluded that for the similar cumulative costs required for the patients on the two systems, the Y-set disconnect has a better morbidity profile than the conventional spike system.

scholarly journals Management of peritoneal dialysis Mycobacterium abscessus exit-site infection: A case report and literature review

2021 ◽  
pp. 112972982110150
Author(s):  
Korey Bartolomeo ◽  
Mohamed Hassanein ◽  
Tushar J Vachharajani
Keyword(s):  
Peritoneal Dialysis ◽  
Mycobacterium Abscessus ◽  
High Morbidity ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Empiric Antibiotic ◽  
End Stage

Peritoneal dialysis associated infections are common and associated with high morbidity and mortality, if not treated in a timely manner. Mycobacterium abscessus is an uncommon pathogen in peritoneal dialysis associated infections, but is resistant to standard antimicrobial therapies used. Here we present a case of a 56 year-old male with end stage kidney disease on peritoneal dialysis for 7 years who developed a Mycobacterium abscessus exit-site infection. Peritonitis and peritoneal dialysis catheter tunneled line infections were ruled out and he was treated with linezolid, amikacin, and azithromycin. He required peritoneal dialysis catheter removal and hemodialysis conversion. Antibiotics were de-escalated based on erm inducibility and antibiotic sensitivities. Linezolid and amikacin were continued for approximately 7 total weeks, with complete resolution of the infection. Further research is needed to refine challenges in the management of Mycobacterium abscessus exit-site infections, including risk factors for development of Mycobacterium abscessus, optimal selection of empiric antibiotic therapies, duration of antibiotics, and peritoneal dialysis catheter re-insertion timing.

“Pulse” Nasal Mupirocin Maintenance Regimen in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 20 (11) ◽  
pp. 741-745 ◽  
Author(s):  
Joseph M. Mylotte ◽  
Lucinda Kahler ◽  
Ellen Jackson
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Effects ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Site Infection ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin ◽  
The Mean

AbstractObjective:To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who wereStaphylococcus aureusnasal carriers, if periodic brief “pulses” of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage.Design:Noncomparative, nonblinded study with historical controls.Setting:A county medical center.Patients:Patients in a CAPD program during the period April 1996 to May 1998.Methods:All patients in the CAPD program had monthly nasal cultures forS aureus. After informed consent,S aureusnasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen.Results:Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate orS aureusperitonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998;P=.008) and due toS aureus(from 5.6 in 1995 to 0.9 in 1998;P=.03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin.Conclusions:Among CAPD patients who wereS aureusnasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.

scholarly journals Exteriorizing the Outer Cuff to Treat Intractable Exit Site Infection and Tunnel Infection in Peritoneal Dialysis Cases: A Single Institute Experience

2020 ◽  
pp. 1-3
Author(s):  
Tsung I Hung ◽  
Ching Shya Yong ◽  
Juiting Chang ◽  
Tsung I Hung ◽  
Wei Ting Chang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Treatment Method ◽  
Residual Renal Function ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is an important treatment method for patients with end stage renal disease. Since its introduction in 1975, clinical studies have shown that PD can improve patient survival, retain residual renal function, and lower the risk of infection. It can also reduce financial stress in the growing population with end stage renal disease. However, PD has limitations, mainly technique failures. Of these, catheterrelated infection is a major cause of catheter failure in PD. We reviewed the medical records of 986 PD patients from 2008 to 2018 at our hospital. The patients with intractable tunnel and exit site infection received exteriorization of the outer cuff and cuff shaving. The favourable outcomes observed recommend this treatment for PD patients whose catheter infection is not well controlled.

Exit Site Infection Due to Non Tuberculous Mycobacterium

2013 ◽  
Vol 24 (1) ◽  
pp. 44
Author(s):  
Rapur Ram ◽  
Gudithi. Swarnalatha ◽  
C. Shyamsunar Rao ◽  
G. Diwakar Naidu ◽  
Kaligotla Venkata Dakshinamurty
Keyword(s):  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection

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.

scholarly journals SP440EXIT SITE RELOCATION: A NOVEL TECHNIQUE FOR EXIT SITE INFECTION

2016 ◽  
Vol 31 (suppl_1) ◽  
pp. i238-i238
Author(s):  
Dimitrios Kirmizis ◽  
Elaine Bowes ◽  
Behzad Ansari ◽  
Hugh S. Cairns
Keyword(s):  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Novel Technique
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