scholarly journals Effect of the Patient's Knowledge on Peritonitis Rates in Peritoneal Dialysis

2013 ◽  
Vol 33 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Suheir A.M. Sayed ◽  
Hasan Abu-Aisha ◽  
Magda E. Ahmed ◽  
Sarra Elamin
Keyword(s):  
Peritoneal Dialysis ◽  
Home Visit ◽  
Assessment Tool ◽  
Knowledge Score ◽  
Housing Conditions ◽  
Infection Rates ◽  
Exit Site ◽  
Treatment Protocols ◽  
Exit Site Infection ◽  
Recommended Treatment

IntroductionAfter a training period, patients maintained on continuous ambulatory peritoneal dialysis (CAPD) assume responsibility for their own treatment. With the aid of appropriate tools, home visits help with ongoing evaluation and training for these patients.MethodsWe conducted a home visit survey of 50 patients maintained on CAPD in Sudan between April 2009 and June 2010. Housing conditions, home environment, and patient's or caregiver's knowledge about peritoneal dialysis and the exchange procedure were evaluated using structured data collection sheets. Scores were compared with infection rates in the patients before the home visit.ResultsPatients were maintained on CAPD for a median duration of 11 months. Their mean age was 42 ± 23 years; 70% were male; and 14% had diabetes. Only 34% of patients had suitable housing conditions, and 56% required assisted PD. Of the autonomous patients and assisting family members, 11.6% were illiterate. The median achieved knowledge score was 11.5 of 35 points. The median achieved exchange score was 15 of 20 points. Knowledge and exchange scores were positively and significantly correlated ( R = 0.5, p = 0.00). More patients in the upper quartile than in the middle and lower quartiles of knowledge scores were adherent to daily exit-site care (33.3% vs 5.3%, p = 0.02). Compared with patients in the middle and lower quartiles of knowledge score, patients in the upper quartile had lower rates of peritonitis, exit-site infection, and hospitalization.ConclusionsThe proposed evaluation form is a valid and reliable assessment tool for the follow-up of CAPD patients. Patients in the upper quartile of knowledge score demonstrated better adherence to the recommended treatment protocols and lower infection rates.

A Comparison of Peritoneal Dialysis-Related Infections in Black and White Patients

1993 ◽  
Vol 13 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Jean L. Holley ◽  
Judith Bernardini ◽  
Beth Piraino
Keyword(s):  
Peritoneal Dialysis ◽  
Outcome Data ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Black And White ◽  
Black Patients ◽  
Insulin Dependence ◽  
White Control ◽  
White Patients

Objective To determine if black patients in our peritoneal dialysis (PD) program had higher rates of PD-related infections. The outcomes of black patients versus white patients were also reviewed. Design A review of prospectively collected patient demographic and PD-related infection data and out comes, from 1979 to 1991. Patients The 68 black patients in our PD program were matched with white control patients for age, sex, insulin dependence, time on dialysis, and mode of dialysis (CAPD or CCPD). The infection, demographic, and outcome data from the two groups were compared. Results Black patients had higher peritonitis rates (1.10 vs 0.82 episodeslyear, p=0.001) and exit-site infection rates (1.13 vs 0.95 episodeslyear, p=0.02) than the white control patients. Tunnel infection rates were 0.21 episodeslyear in both groups. S. epidermidis peritonitis was more common in black patients (48% of episodes vs 21% of episodes in whites, p=0.005), and S. aureus peritonitis was more common in white patients (29% vs 11% in blacks, p=0.005). The subset of black patients (n=13) on a disconnect system (Y-set) had a peritonitis rate similar to their white controls on the Y-set (0.41 vs 0.74 episodes/year, p=0.27). There were no episodes of S. epidermidis peritonitis in this subset of black patients. Black patients had fewer S. aureus exit-site infections than white patients (21% vs 41%, p=0.005). Peritonitis was the leading cause of transfer to hemodialysis in the black patients but not in the white patients. Conclusion The susceptibility to S. aureus and S. epidermidis infections differs in black and white patients on peritoneal dialysis for unclear reasons. Peritonitis rates in black patients can be reduced to that of white patients if a disconnect system is used.

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.

Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey

2009 ◽  
Vol 29 (3) ◽  
pp. 330-339 ◽  
Author(s):  
Gertrude Kopriva–Altfahrt ◽  
Paul König ◽  
Michael Mündle ◽  
Friedrich Prischl ◽  
Johannes M. Roob ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Infection Rate ◽  
Sodium Hypochlorite ◽  
Povidone Iodine ◽  
Nationwide Survey ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Staff Members ◽  
Octenidine Dihydrochloride

Background Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. Methods In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. Results Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. Conclusion Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).

Continuous Ambulatory Peritoneal Dialysis in Egypt: Progression despite Handicaps

2010 ◽  
Vol 30 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Khaled M. Mahmoud ◽  
Hussein A. Sheashaa ◽  
Osama A. Gheith ◽  
Ehab W. Wafa ◽  
Amgad E. Agroudy ◽  
...  
Keyword(s):  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Biochemical Assessment ◽  
And Training ◽  
Culture Negative

♦ BackgroundDespite the well-known advantages of continuous ambulatory peritoneal dialysis (CAPD), it continues to be grossly underutilized in many developing countries. However, some developing countries, such as Mexico, use the modality very effectively. In view of this, we started the first CAPD program in Egypt.♦ MethodsSince its start in 1997, our program has treated 33 patients. Straight double-cuffed Tenckhoff catheters were surgically placed in all patients. Twin-bag systems were used. All patients underwent monthly clinical and biochemical assessment and measurement of Kt/V urea. Peritonitis and exit-site infection rates were monitored.♦ ResultsMost treated patients were adult and female. Mean age was 31.7 years and mean follow-up duration was 18 months. Peritonitis rate was 1 episode /21.3 months and was easily managed in most patients. Staphylococcus aureus was the most commonly isolated organism (24%) but 49% of cases were culture negative. There were no exit-site infections. Mean weekly Kt/V urea was 1.78 ± 0.23.♦ ConclusionWe report the successful development of a small CAPD program in Egypt, made possible by well-established financial support, a motivated team of doctors and nurses, and good patient selection and training.

Higher Incidence of Peritonitis in Native Canadians on Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Adrian Fine ◽  
Darlyne Cox ◽  
Maria Bouw
Keyword(s):  
Peritoneal Dialysis ◽  
Host Factors ◽  
Site Infection ◽  
Infection Rates ◽  
Native Population ◽  
Exit Site ◽  
Exit Site Infection ◽  
Additional Risk ◽  
Native Canadians ◽  
Intraperitoneal Insulin

Objective To determine if the rate of peritoneal dialysis (PD)-related infections in our large Native population was higher than in non-Natives. Design Prospective study of PD-related infections, 1987 to 1993. Patients Forty-eight Natives and 136 non-Natives were studied. Comparisons of infection rates were made as well as determinations of the effect of diabetes and of dialysis techniques on infection rate. Results The chance of remaining free of peritonitis was far lower at 6 and 12 months in Natives versus nonNatives, 40% versus 76% at 6 months, and 24% versus 54% at 12 months (p < 0.01). Having diabetes or adding intraperitoneal insulin did not confer additional risk of peritonitis. The Y-Iine reduced the risk of peritonitis in non-Natives only. Exit-site infection (ESI) was significantly higher in Natives versus non-Natives, 0.42 versus 0.19 episodes per patient year (p < 0.01) mainly due to Staph. aureus. However, less than 30% of episodes of peritonitis were due to that organism. Staph. epidermidis peritonitis episodes were not more common in Native patients, whereas infections due to most other organisms were. Conclusion The susceptibility to both peritonitis and exit-site infection is increased in Native Canadians compared to non-Natives. The non protective effect of the Yline combined with increased peritonitis due to most organisms except Staph. epidermidis in Natives suggests that host factors could be important in these patients.

“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.

Exit-Site Care with Ciprofloxacin Otologic Solution Prevents Polyurethane Catheter Infection in Peritoneal Dialysis Patients

2000 ◽  
Vol 20 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Jesús Montenegro ◽  
Ramón Saracho ◽  
Román Aguirre ◽  
Isabel Martínez ◽  
Izakun Iribar ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Insertion Site ◽  
Exit Site ◽  
Treatment Protocols ◽  
Exit Site Infection ◽  
Polyurethane Catheter ◽  
Group 2 ◽  
Mupirocin Ointment ◽  
Polyurethane Catheters ◽  
Group 1

Objective Mupirocin ointment and antiseptics are standard cleansing agents in routine exit-site care of peritoneal dialysis (PD) catheters, but these agents have a deleterious effect on polyurethane devices. We assessed the effectiveness of topical use of ciprofloxacin otologic solution for preventing exit-site infection (ESI) in PD patients with polyurethane catheters. Design Prospective study. Setting Service of Nephrology of an acute-care teaching hospital in Galdácano, Bizkaia, Spain. Patients A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month period. Patients were divided into two groups according to exit-site treatment protocols. Intervention Patients in group 1 ( n = 86) were instructed on daily exit-site care with soap and water only; whereas patients in group 2 ( n = 78) cleansed with soap and water, followed by application of a single-dose vial of 0.5 mL ciprofloxacin (1 mg) for application around the insertion site. Main Outcome Measures Episodes of ESI and peritonitis. Results There were 67 episodes of ESI among patients in group 1 versus 9 episodes among patients in group 2 ( p < 0.05), resulting in a rate of 0.41 and 0.06 episodes per patient-year of exposure, respectively ( p < 0.001). Staphylococcus aureus ESI rate was 0.34 in group 1 versus 0.06 in group 2 ( p = 0.001). Infections caused by Pseudomonas aeruginosa and other pathogens occurred in 11 patients in group 1 and in no patients in group 2 ( p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among patients treated with ciprofloxacin (1 vs 9 cases, p = 0.001). Removal of the catheter was necessary in 5 patients in group 1 and in no patients in group 2 ( p < 0.05). Conclusion Daily application of ciprofloxacin otologic solution at the exit site of PD patients with polyurethane catheters inserted significantly reduces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.

Effects of Peritoneal Dialysis Solutions Low in GDPs on Peritonitis and Exit-Site Infection Rates

2008 ◽  
Vol 28 (6) ◽  
pp. 637-640 ◽  
Author(s):  
Jürgen Furkert ◽  
Martin Zeier ◽  
Vedat Schwenger
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Infection Rates ◽  
Exit Site ◽  
Duration Of Treatment ◽  
Exit Site Infection ◽  
New Treatment ◽  
Ph Level ◽  
Dialysis Solutions ◽  
Dialysis Fluids

Background Peritoneal dialysis (PD) solutions sterilized at a low pH level contain only minimal amounts of glucose degradation products (GDPs). The latter are known to have an adverse effect on the peritoneal membrane. The present study retrospectively analyzes the effects on the incidences of peritonitis and exit-site infections. Materials and Methods Data concerning the frequency of peritonitis and exit-site infections for 120 patients treated with PD were collected. Before 2000, 67 of these patients received conventional dialysates and from 2000 on, 53 patients were treated with the new dialysis fluids. Furthermore, a correlation between the incidence of infections and the duration of treatment with dialysis was established. Results It was observed that the use of dialysis solutions low in GDPs resulted in significantly lower rates of peritonitis ( p = 0.002) and exit-site infections ( p = 0.02). When using the new treatment, peritonitis occurred, on average, after 48 months of treatment and exit-site infections after 34 months of treatment. Discussion The result supports the hypothesis that the use of the new, biocompatible, PD solutions contributes to considerable reduction in the rates of peritonitis and exit-site infections. As it is not expected that randomized prospective studies will be conducted in the future, further observational studies should be carried out in order to affirm the observed tendencies.

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.

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