Persistent Exit-Site “Infection” in a Peritoneal Dialysis Patient with Chronic Lymphocytic Leukemia

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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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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Peritoneal Dialysis in the Prune Belly Syndrome

Peritoneal Dialysis International ◽

10.1177/089686089401400103 ◽

1994 ◽

Vol 14 (1) ◽

pp. 17-21 ◽

Cited By ~ 11

Author(s):

Charles H. Crompton ◽

J. Williamson Balfe ◽

Antoine Khoury

Keyword(s):

Peritoneal Dialysis ◽

Laparoscopic Technique ◽

Prune Belly Syndrome ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Prune Belly ◽

Tunnel Infection ◽

Chronic Ambulatory Peritoneal Dialysis ◽

Catheter Replacement

Objectives To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS). Design From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion. Results The ages of the 6 boys ranged from 10 months 17 years. The dialysis duration was from 9–22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery. Conclusion Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.

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Staphylococcus Aureus Prophylaxis and Trends in Gram-Negative Infections in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080302300509 ◽

2003 ◽

Vol 23 (5) ◽

pp. 456-459 ◽

Cited By ~ 49

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.

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