Recurrent Exit-Site Infection Due to Staphylococcus lugdunensis—A Virulent Coagulase-negative Staphylococcus

We reviewed 30 patients in an automated peritoneal dialysis (APD) program from 2002 to 2006 for peritonitis. Patients were 11.6 ± 5.5 years old at initiation of peritoneal dialysis (PD) and had a total of 976 PD months. The overall peritonitis rate was 1 episode in 54.2 patient– months, for a rate of 0.22 episode annually. The rate was considered low, which other than being an APD program, may be attributed to adherence to guidelines and in-charge nurse policy. A total of 17 episodes of peritonitis were identified in 9 patients, and the distribution of patient-specific peritonitis incidence appeared bimodal: 87% patients had no or only 1 episode of peritonitis, and 4 patients accounted for 12 episodes, with an average peritonitis rate of 1.0 annually. Causative organisms included Staphylococcus aureus, coagulase-negative Staphylococcus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, enterococci, alpha-hemolytic Streptococcus. Five episodes had concurrent exit-site infection with the same organism. During the same period in these 30 patients, 40 episodes of exit-site infection (ESI) were recorded in 23 patients. The overall ESI rate was 1 episode in 24.4 PD months. S. aureus and Pseudomonas aeruginosa were the two most common pathogens, accounting for 70% of the infections. Nasal carriage of MRSA was found in 4 patients, and MRSA ESIs in 2. The ESI rate was not low as that observed in peritonitis, which may be attributed to the humid climate.

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Exit Site Infection Due to Non Tuberculous Mycobacterium

Indian Journal of Peritoneal dialysis ◽

10.15582/ijpd/2013/50657 ◽

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

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Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06342-x ◽

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.

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Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children

Peritoneal Dialysis International ◽

10.1177/089686089001000108 ◽

1990 ◽

Vol 10 (1) ◽

pp. 31-35 ◽

Cited By ~ 18

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.

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SP440EXIT SITE RELOCATION: A NOVEL TECHNIQUE FOR EXIT SITE INFECTION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw171.11 ◽

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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Obesity and Left Ventricular Assist Device Driveline Exit Site Infection

ASAIO Journal ◽

10.1097/mat.0b013e3181c879b1 ◽

2010 ◽

Vol 56 (1) ◽

pp. 57-60 ◽

Cited By ~ 76

Author(s):

Ashley L. Raymond ◽

Abdallah G. Kfoury ◽

Corey J. Bishop ◽

Erin S. Davis ◽

Kimberly M. Goebel ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Site Infection ◽

Exit Site ◽

Assist Device ◽

Ventricular Assist ◽

Exit Site Infection ◽

Left Ventricular Assist

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The Efficacy of Silver-Ion Implanted Catheters in Reducing Peritoneal Dialysis-Related Infections

Peritoneal Dialysis International ◽

10.1177/089686080302300410 ◽

2003 ◽

Vol 23 (4) ◽

pp. 368-374 ◽

Cited By ~ 1

Author(s):

John H. Crabtree ◽

Raoul J. Burchette ◽

Rukhsana A. Siddiqi ◽

Isan T. Huen ◽

Linda L Hadnott ◽

...

Keyword(s):

Ion Beam ◽

Controlled Trial ◽

Silver Ion ◽

Control Group ◽

Site Infection ◽

Control Groups ◽

Exit Site ◽

Exit Site Infection ◽

Catheter Survival ◽

And Control

♦ Background Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. ♦ Objective The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. ♦ Methods The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. ♦ Results The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis ( p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis ( p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections ( p = 0.58), peritonitis ( p = 0.44), or both infections combined ( p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection ( p> 0.2) or peritonitis ( p > 0.7). Similarly, catheter survival was not significantly different between the groups ( p > 0.6). ♦ Conclusion Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

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A Case of Exit-Site Infection and Abscess byMycobacterium Abscessusin a CAPD Patient

Yeungnam University Journal of Medicine ◽

10.12701/yujm.2009.26.2.137 ◽

2009 ◽

Vol 26 (2) ◽

pp. 137 ◽

Cited By ~ 2

Author(s):

Sun-young Jung ◽

Ji-hoon Na ◽

Kyu-hyang Cho ◽

Jong-won Park ◽

Jun-young Do ◽

...

Keyword(s):

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Capd Patient

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The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients

Yeungnam University Journal of Medicine ◽

10.12701/yujm.1999.16.2.347 ◽

1999 ◽

Vol 16 (2) ◽

pp. 347

Author(s):

Jun Beom Park ◽

Jung Mee Kim ◽

Jun Hyuk Choi ◽

Kyu Hyang Jo ◽

Hang Jae Jung ◽

...

Keyword(s):

Site Infection ◽

Exit Site ◽

Exit Site Infection

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The Effect of Exit-Site Antibacterial Honey versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00206 ◽

2015 ◽

Vol 35 (7) ◽

pp. 712-721 ◽

Cited By ~ 8

Author(s):

Lei Zhang ◽

Sunil V. Badve ◽

Elaine M. Pascoe ◽

Elaine Beller ◽

Alan Cass ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Site Infection ◽

Control Groups ◽

Exit Site ◽

Exit Site Infection ◽

Gram Negative ◽

Nasal Mupirocin ◽

And Control ◽

Technique Failure ◽

Culture Negative

Background The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. Methods A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care ( N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 – 0.50) and 0.41 (95% CI 0.33 – 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 – 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 – 1.49), gram-negative (IRR 0.71, 95% CI 0.39 – 1.29), culture-negative (IRR 2.01, 95% CI 0.91 – 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 – 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 – 0.45) and 0.33 (95% CI 0.26 – 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 – 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 – 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 – 1.58), culture-negative (IRR 1.88, 95% CI 0.67 – 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 – 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

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