scholarly journals 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

2015 ◽  
Vol 35 (7) ◽  
pp. 712-721 ◽  
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.

Factors Contributing to the Differences in Peritonitis Rates between Centers and Regions

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 281-285 ◽  
Author(s):  
Andrea E. Stinghen ◽  
Pasqual Barretti ◽  
Roberto Pecoits–Filho
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Selection ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Significant Percentage ◽  
Technological Advances ◽  
The World ◽  
Culture Negative

Despite improvements in connectology, peritoneal dialysis (PD)–associated peritonitis contributes significantly to morbidity and modality failure in patients maintained on PD therapy. A broad spectrum of organisms—gram-positive, gram-negative, fungal, anaerobic—are involved in this complication. In addition, a significant percentage of episodes involve polymicrobial and culture-negative infection. Technological advances are being developed to minimize the incidence of access-related complications such as peritonitis. Many traditional factors such as exit-site infection and poor technique have been already identified. In the present review, we discuss the geographic, patient selection, and clinical issues that can affect peritonitis rates in different areas of the world and in different centers in the same area.

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

2003 ◽  
Vol 23 (4) ◽  
pp. 368-374 ◽  
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.

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

2003 ◽  
Vol 23 (5) ◽  
pp. 456-459 ◽  
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.

“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 Predictive factors of outcome following nonfermenting gram-negative bacilli peritonitis in peritoneal dialysis

2020 ◽  
Author(s):  
Ana Claudia Moro Lima dos Santos ◽  
Rodrigo Travanelli Hernandes ◽  
Augusto Cezar Montelli ◽  
Aydir Cecília Marinho Monteiro ◽  
Thais Alves Barbosa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Virulence Factors ◽  
Site Infection ◽  
Low Resolution ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Resolution Rate ◽  
Biofilm Production

Abstract Background Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis (PD) with a low resolution rate. Beyond the patient’s condition, microbiological properties such as antimicrobial resistance, biofilms and the production of other virulence factors can explain the bad outcomes. This study aimed to evaluate the influence of the patient’s condition, the microbiological characteristics, including biofilm production, and the treatment of peritonitis on peritonitis resolution.Methods We reviewed the records of 62 new peritonitis episodes caused by NF-GNB that occurred between 1997 and 2015 at a single university center. The influence of microbiological and clinical factors on resolution chance was analyzed by logistic regression.Results The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and others (16.1%). There was a high (72.9%) proportion of biofilm producers’ lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (<45%) among the episodes attributable to Pseudomonas spp, Acinetobacter spp, and other NF-GNB. Pre-existent exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. Conclusions Peritonitis due to NF-GNB in PD is a severe infection with a reduced resolution rate, and pre-existent exit site infection negatively influences the chance of resolution. The higher in vitro susceptibility of Pseudomonas compared to that of other NF-GNB with a similar resolution rate, suggests bacterial virulence factors beyond biofilm and can act in concert, thereby worsening the outcome.

scholarly journals Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

1996 ◽  
Vol 7 (11) ◽  
pp. 2403-2408
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Treatment Group ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

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.

Peritoneal Dialysis in the Prune Belly Syndrome

1994 ◽  
Vol 14 (1) ◽  
pp. 17-21 ◽  
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.

Subcutaneous Cuff Migrates after Initiation of Peritoneal Dialysis

2018 ◽  
Vol 38 (3) ◽  
pp. 229-231
Author(s):  
Tsutomu Sakurada ◽  
Hitoshi Kotake ◽  
Kenichiro Koitabashi ◽  
Yugo Shibagaki
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Retrospective Study ◽  
Site Infection ◽  
Background Characteristics ◽  
Single Center ◽  
Exit Site ◽  
Exit Site Infection ◽  
Factors Affecting ◽  
History Of

The aim of this study was to determine whether subcutaneous cuffs migrate toward the exit site after initiation of peritoneal dialysis (PD) and to clarify the factors affecting such migration. Subcutaneous cuff migration was defined as extension of the length of the external catheter. In this single-center, retrospective study, the external catheter lengths at initiation and 1 year later were compared in 33 PD patients (median age 62 years; 64% men; 49% with diabetes mellitus). The correlations between patient background characteristics at initiation and extension of catheter length were also examined. The external catheter length was significantly extended at 1 year later (13.5 vs 15.0 cm, p < 0.001). There was no relationship between a history of exit-site infection and extension of catheter length ( p = 0.250). Hemoglobin (r = -0.447, p = 0.009), serum albumin (r = -0.377, p = 0.031), and external catheter length at initiation (r = -0.350, p = 0.046) showed negative correlations with extension. In conclusion, subcutaneous cuff migration was observed in just 1 year and may be associated with malnutrition, anemia, and short external catheter length at initiation of PD.

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