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.

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.

Oral versus Intraperitoneal Application of Clindamycin in Tunnel Infections: A Prospective, Randomized Study in Capd Patients

1997 ◽  
Vol 17 (5) ◽  
pp. 486-492 ◽  
Author(s):  
Joerg Plum ◽  
Suzan Artik ◽  
Theo Busch ◽  
Kurtulus Sahin ◽  
Bernd Grabensee
Keyword(s):  
Randomized Study ◽  
Fluid Collection ◽  
Oral Route ◽  
Study Entry ◽  
Prospective Randomized Study ◽  
Exit Site ◽  
Exit Site Infection ◽  
Significant Difference ◽  
Oral Group ◽  
Intraperitoneal Treatment

Objective To evaluate the potential superiority of either oral or intraperitoneal treatment of catheter tunnel infections (TI), using clindamycin as a first-Iine antibiotic and ultrasound as a diagnostic tool. Design This was a prospective, randomized study in continuous ambulatory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically and ultrasound-proven episodes of TI were randomly assigned to either an oral or an intraperitoneal (IP) treatment (100 patients, 1414 patient-months). Main criteria for TI diagnosis were purulent drainage from the exit site and/or a positive ultrasound (pericatheter fluid collection of at least 2 mm, 7.5 MHz transducer). Initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case of incompatibility or resistance to clindamycin, either oxacillin orciprofloxacin were used orally or IP. Results Based on ultrasound criteria, the mean time until a ≥50% reduction of pericatheter abscess diameter was 26 days (median) (range: 8 28 days) in the oral, and 15 days (8 27 days) in the IP group (p ≤ 0.05). Showing no significant difference of pericatheter fluid at study entry with 4 mm (median) (range: 2 -6 mm) in the oral group and 4 mm (2 -4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0 2 mm) after 28 days (p < 0.05), while the diameter was still 2 mm (0 10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitoneal group (51 vs 15 days, NS). Catheter removal had to be done once in the IP group and twice in the oral group within 6 months after study entry. Conclusions The results give evidence for greater efficacy of the IP application of clindamycin as a first -Iine antibiotic compared to the oral route for the treatment of tunnel infections.

scholarly journals Alternating Mupirocin/Gentamicin is Associated with Increased Risk of Fungal Peritonitis as Compared with Gentamicin Alone – Results of a Randomized Open-Label Controlled Trial

2016 ◽  
Vol 36 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Ping-Nam Wong ◽  
Gensy M. W. Tong ◽  
Yuk-Yi Wong ◽  
Kin-Yee Lo ◽  
Shuk-Fan Chan ◽  
...  
Keyword(s):  
Topical Application ◽  
Catheter Removal ◽  
Exit Site ◽  
Open Label ◽  
Exit Site Infection ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Catheter Related Infection ◽  
Dialysis Vintage ◽  
Significant Difference

Background and Objectives Catheter-related infection, namely exit-site infection (ESI) and peritonitis, is a major infectious complication and remains a main cause of technique failure for patients receiving peritoneal dialysis (PD). Topical application of antibiotic cream might reduce catheter-related infection but emergence of resistant or opportunistic organisms could be a concern. Optimal topical agents and regimens remain to be determined. We did a study to examine the effect of an alternating topical antibiotic regimen in preventing catheter-related infection. Method We performed a single-center, randomized, open-label study to compare daily topical application of gentamicin cream with a gentamicin/mupirocin alternate regimen to the exit site. Patients randomized to alternating regimen were asked to have daily application of gentamicin cream in odd months and mupirocin cream in even months. Primary outcomes were ESI and peritonitis. Secondary outcomes were catheter removal or death caused by catheter-related infection. A total of 146 patients (71, gentamicin group; 75, alternating regimen group) were enrolled with a total follow-up duration of 174 and 181 patient-years for gentamicin and alternating groups, respectively. All patients were followed up until catheter removal, death, transfer to another unit, transplantation or the end of the study on March 31, 2014. There were no significant differences in the age, sex, dialysis vintage, and rate of diabetes, helper-assisted dialysis and methicillin-resistant Staphylococcus aureus (MRSA) carriage state. Results No difference was seen in the time to first ESI or peritonitis. However, the time to first gram-negative peritonitis seemed longer for the gentamicin group ( p = 0.055). The 2 groups showed a similar rate of ESI (0.17/yr vs 0.19/yr, p = 0.93) but P. aeruginosa ESI was less common in the gentamicin group (0.06/yr vs 0.11/yr, p < 0.001). There was no difference in the incidence of ESI due to non-tuberculous mycobacteria. Peritonitis rate was significantly lower in the gentamicin group (0.22/yr vs 0.32/yr, p < 0.001), with a striking decrease in gram-negative peritonitis (0.08/yr vs 0.14/yr, p < 0.001), and fungal peritonitis (0.006/yr vs 0.03/yr, p < 0.001), which was all antibiotics-related episodes with antecedent use of systemic antibiotics for the treatment of catheter-related infections. There was no significant difference in the catheter loss or death related to catheter-related infection. Conclusion Alternating gentamicin/mupirocin cream application appeared as effective as gentamicin alone in preventing ESI except for P. aeruginosa. However, it was inferior to gentamicin in the prevention of peritonitis episodes, especially for those caused by gram-negative organisms. It was also not useful in reducing catheter-related infection due to opportunistic organisms but instead associated with a higher incidence of antibiotic-related fungal peritonitis.

scholarly journals COVID 19 Pneumonia and a Rare Form of Fungal Peritonitis in a Patient Survivor on Peritoneal Dialysis

PRILOZI ◽  
2021 ◽  
Vol 42 (3) ◽  
pp. 57-62
Author(s):  
Pavlina Dzekova-Vidimliski ◽  
Vlatko Karanfilovski ◽  
Galina Severova ◽  
Lada Trajceska ◽  
Irena Rambabova-Bushljetik ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Wide Spectrum ◽  
Fungal Growth ◽  
Peritoneal Membrane ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Sudden Appearance

Abstract Peritoneal dialysis (PD) related peritonitis is usually caused by bacteria, but viruses and fungi could also affect the peritoneal membrane and cause cloudy effluent with negative bacterial cultures. We present a case of a PD patient who survived fungal peritonitis caused by Geotrichum klebahnii (March 2015) and COVID-19 pneumonia (April 2021) with peritonitis probably caused by the SARS-CoV-2 virus. The fungal peritonitis followed one episode of exit-site infection and two episodes of bacterial peritonitis treated with a wide-spectrum antibiotic. The patient’s PD catheter was removed immediately upon the diagnosis of fungal peritonitis, and an antifungal treatment was continued for 3 weeks after catheter removal. The new peritoneal catheter was reinserted 8 weeks after complete resolution of peritonitis, and the patient continued treatment with PD. The patient developed severe Covid-19 pneumonia with a sudden appearance of cloudy peritoneal effluent. There was no bacterial or fungal growth on the effluent culture. A PCR test for SARS-CoV-2 in peritoneal effluent was not performed. The peritoneal effluent became transparent with the resolution of the severe symptoms of Covid-19 pneumonia.

Capd Therapy for Patients over 80 Years of Age

1993 ◽  
Vol 13 (2) ◽  
pp. 140-141 ◽  
Author(s):  
Nancy Gorban-Brennan ◽  
Alan S. Kliger ◽  
Fredric O. Finkelstein
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Therapeutic Option ◽  
Hospitalization Rate ◽  
Family Assessment ◽  
Gram Positive Bacteria ◽  
Duration Of Therapy ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Objective The purpose of the study is to review our experience with patients over 80 years of age with end stage renal disease (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD). Design The records of all patients over 80 years of age treated in our unit with CAPD since 1979 were reviewed. Setting Outpatient CAPD facility. Patients Eighteen patients over 80 years of age were identified and studied. Main Outcome Measures The duration of CAPD therapy, duration of CAPD training, mortality rate, hospitalization rate, peritonitis rate, and family assessment were reviewed and analyzed. Results The mean ± SD duration of therapy was 20±17 months. Nine patients expired, 3 transferred to hemodialysis, 1 recovered renal function, and 5 remained on CAPD therapy. Peritonitis rates were 1.7 episodes/patient year. Of the organisms causing peritonitis, 56% were gram-positive bacteria. The average hospitalization rate was 13.9 days/patient year. The most frequent causes of hospitalization were peritonitis and cardiovascular disease. Conclusion CAPD therapy is a reasonable therapeutic option for patients with end-stage renal disease over 80 years of age.

scholarly journals Twin- versus single-bag disconnect systems: infection rates and cost of continuous ambulatory peritoneal dialysis.

1996 ◽  
Vol 7 (11) ◽  
pp. 2392-2398 ◽  
Author(s):  
D C Harris ◽  
E J Yuill ◽  
K Byth ◽  
J R Chapman ◽  
C Hunt
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Randomized Study ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Total Cost ◽  
Purchase Cost ◽  
Fluid Transfer

Although twin-bag disconnect fluid-transfer systems for continuous ambulatory peritoneal dialysis (CAPD) have a lower rate of catheter-related infection than single-bag systems, their greater monetary purchase cost has prevented universal adoption. Therefore, a single-center randomized study was performed in 63 adult patients to compare the efficiency and total cost of Freeline Solo (FS, twin-bag) and Basic Y (BY, single-bag) systems. Patients were new to CAPD (N = 39), or had a new CAPD catheter, or had had no episodes of peritonitis or exit-site infection in the previous 12 months (N = 24). Total follow-up was 631 patient months (pt.mon), and 53 patients were still on the trial at its termination. Patients rated FS as easier to use than BY (P < 0.001). Peritonitis occurred on 23 occasions in 12 out of 30 patients using BY, and on seven occasions in five of 33 patients using FS. Time to first infection was less with BY than FS (hazard ratio, 2.4; 95% confidence interval (CI), 1.0 to 5.3; P < 0.04). Cumulative incidence of peritonitis was 1 per 14.0 pt.mon with BY and 1 per 46.5 pt.mon with FS (odds ratio, 3.6; 95% CI 1.5 to 8.5; P = 0.004). Length of hospitalization for peritonitis or exit-site infection was 98 days in six patients with BY, versus 17 days in two patients with FS. With BY, four catheters were removed because of infection, but none with FS (P < 0.05). With BY, the total cost of infection was $AUD127,079 ($5033 per pt.yr) versus $19,250 ($704 per pt.yr) with FS, which offset the higher purchase cost of FS. The total cost of CAPD was $AUD956 per pt.yr less with FS than BY. In conclusion, the higher purchase cost of the FS twin-bag system is more than offset by savings from its lower incidence of peritonitis.

Comparison of Topical Chlorhexidine and Mupirocin for the Prevention of Exit-Site Infection in Incident Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (3) ◽  
pp. 266-272 ◽  
Author(s):  
Htay Htay ◽  
David W. Johnson ◽  
Sin Yan Wu ◽  
Elizabeth Ley Oei ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Hospitalization Rate ◽  
Catheter Removal ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Singapore General Hospital

Objective Prevention of exit-site infection (ESI) is of paramount importance to peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effectiveness of chlorhexidine in the prevention of ESI in incident PD patients compared with mupirocin. Methods This retrospective, pre-test/post-test observational study included all incident PD patients at Singapore General Hospital from 2012 to 2015. Patients received daily topical exit-site application of either mupirocin (2012 – 2013) or chlorhexidine (2014 – 2015) in addition to routine exit-site cleaning with 10% povidone-iodine. The primary outcome was ESI rate during the 2 time periods. Secondary outcomes were peritonitis rate, times to first ESI and peritonitis, hospitalization rate, and infection-related catheter removal. Event rates were analyzed using Poisson regression, and infection-free survival was estimated using Kaplan-Meier and Cox regression survival analyses. Results The study included 162 patients in the mupirocin period (follow-up 141.5 patient-years) and 175 patients in the chlorhexidine period (follow-up 136.9 patient-years). Compared with mupirocin-treated patients, chlorhexidine-treated patients experienced more frequent ESIs (0.22 vs 0.12 episodes/patient-year, p = 0.048), although this was no longer statistically significant following multivariable analysis (incidence rate ratio [IRR] 1.78, 95% confidence interval [CI] 0.98 – 3.26, p = 0.06). No significant differences were observed between the 2 groups with respect to time to first ESI ( p = 0.10), peritonitis rate ( p = 0.95), time to first peritonitis ( p = 0.60), hospitalization rate ( p = 0.21) or catheter removal rate (0.03 vs 0.04/patient-year, p = 0.56). Conclusions Topical exit-site application of chlorhexidine cream was associated with a borderline significant, higher rate of ESI in incident PD patients compared with mupirocin cream.

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.

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