Repeat Peritoneal Dialysis Exit-Site Infection: Definition and Outcomes

2019 ◽  
Vol 39 (4) ◽  
pp. 344-349 ◽  
Author(s):  
Hannah Beckwith ◽  
Michelle Clemenger ◽  
Jacqueline McGrory ◽  
Nora Hisole ◽  
Titus Chelapurath ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Dialysis Modality ◽  
Site Infection ◽  
Exit Site ◽  
Retrospective Case ◽  
Exit Site Infection ◽  
Catheter Exchange ◽  
Number Of Patients

BackgroundThe most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.MethodsRetrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.ResultsOverall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus ( n = 16, 52%) and Pseudomonas aeruginosa ( n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).ConclusionWe have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.

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.

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.

Emergence of Mupirocin-Resistant Staphylococcus Aureus in Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection

2001 ◽  
Vol 21 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Rajeev Annigeri ◽  
John Conly ◽  
Stephen I. Vas ◽  
Helen Dedier ◽  
Kannam P. Prakashan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Total Study Population ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Mannitol Salt Agar ◽  
High Level

Objective To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. Methods Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. Results Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. Conclusion We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

Toxic Shock Syndrome With Staphylococcus aureus Exit-Site Infection in a Patient on Peritoneal Dialysis

1990 ◽  
Vol 15 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Joseph R. Sherbotie ◽  
Karen Polise ◽  
Andrew Costarino ◽  
Joseph V. DiCarlo ◽  
Bernard S. Kaplan
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Toxic Shock Syndrome ◽  
Site Infection ◽  
Toxic Shock ◽  
Exit Site ◽  
Exit Site Infection

Peritoneal Dialysis in Adult Patients with Permanent Suprapubic Catheter: A Single-Center Experience and Literature Review

2018 ◽  
Vol 38 (6) ◽  
pp. 424-429 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Mohammad Ahmed Nasr El-Din ◽  
Amani Al-Hwiesh ◽  
Aisha Alosail ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Suprapubic Catheter ◽  
Site Infection ◽  
Single Center ◽  
Exit Site ◽  
Exit Site Infection ◽  
Single Center Experience ◽  
Number Of Patients ◽  
The Difference

Background The aim of this paper was to review the feasibility of peritoneal dialysis (PD) in the presence of a permanent supra-pubic catheter over a long follow-up period. Methods Twelve patients with automated PD and permanent suprapubic catheters were studied for complications over a period of 10 years. Results In all 12 patients, PD went smoothly. Two of our patients required removal of the PD catheter due to peritonitis. The overall rate of exit-site infection throughout the study was 41.7/patient-month and the difference between patients 60 years or older and those 25 years or younger was not significant ( p = 0.3673). The overall peritonitis rate for all patients was 38.3 episode/patient-month, and none of the patients with ventriculoperitoneal shunt (VPS) had peritonitis. All patients with episodes of infection responded well to the proper antibiotics. Conclusions The available data supported the feasibility of PD in patients with permanent suprapubic catheters; however, a greater number of patients with a longer follow-up period need to be studied to support our results.

Treatment of Refractory Pseudomonas Aeruginosa Exit-Site Infection by Simultaneous Removal and Reinsertion of Peritoneal Dialysis Catheter

2005 ◽  
Vol 25 (6) ◽  
pp. 560-563 ◽  
Author(s):  
Sing Leung Lui ◽  
Terence Yip ◽  
Kai Chung Tse ◽  
Man Fai Lam ◽  
Kar Neng Lai ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Antibiotic Treatment ◽  
Simultaneous Removal ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Optimal Interval

Background Patients on continuous ambulatory peritoneal dialysis (CAPD) with Pseudomonas aeruginosa exit-site infection (ESI) refractory to antibiotic treatment often require replacement of their peritoneal dialysis catheter (PDC). The optimal interval between removal and reinsertion of the PDC is not known. There are relatively few data on the feasibility of simultaneous removal and reinsertion of dialysis catheters for the treatment of P. aeruginosa ESI. Methods We retrospectively reviewed the short- and long-term outcomes of all CAPD patients who had undergone simultaneous removal and reinsertion of their PDC for the treatment of refractory P. aeruginosa ESI in our hospital between January 1994 and December 2003. During the operation, the old catheter was removed first and a new catheter was inserted into the opposite side of the abdomen. All patients received 7 days of antibiotic therapy postoperatively. CAPD was resumed after 2 weeks of intermittent peritoneal dialysis. Results Over a 10-year period, 37 CAPD patients underwent the operation. Mean age of the patients was 59.5 ± 10.9 years. The interval between the diagnosis of ESI and the operation was 16.7 ± 6.9 weeks. The patients received 7.6 ± 2.5 weeks of antibiotic treatment before the procedure. Early postoperative complications were uncommon. None of the patients developed ESI within 4 weeks after the operation. At 1 year after the operation, 3 patients (8%) had developed recurrence of P. aeruginosa ESI 24 – 40 weeks postoperatively. Peritonitis due to P. aeruginosa was not observed. Conclusions We conclude that simultaneous removal and reinsertion of the PDC is feasible in eradicating refractory ESI due to P. aeruginosa. This procedure alleviates the need for temporary hemodialysis and allows continuation of peritoneal dialysis.

Toxic Shock Syndrome in Two CAPD Patients with Staphylococcus Aureus Exit-Site Infection

2003 ◽  
Vol 23 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Mehmet R. Altiparmak ◽  
Hande Demirel ◽  
Ali Mert ◽  
Kamil Serdengecti ◽  
Rezzan Ataman
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Toxic Shock Syndrome ◽  
Case Definition ◽  
Peritoneal Dialysis Catheter ◽  
Site Infection ◽  
Toxic Shock ◽  
Exit Site ◽  
Exit Site Infection ◽  
Cutaneous Infections

Toxic shock syndrome (TSS) is an illness defined by the occurrence of fever, rash, hypotension, multiple organ system dysfunction, and desquamation. Nonmenstrual TSS is often associated with surgical or nonsurgical cutaneous infections, which are rarely purulent or inflamed (Reingold AL, et al. Nonmenstrual toxic shock syndrome: a review of 130 cases. Ann Intern Med 1982; 96:871–4). Toxic shock syndrome associated with peritoneal exit-site infection but without peritonitis is extremely unusual (Sherbotie JR, et al. Toxic shock syndrome with Staphylococcus aureus exit-site infection in a patient on peritoneal dialysis. Am J Kidney Dis 1990; 15:80–3). We describe 2 patients that met the Centers for Disease Control case definition of TSS secondary to a peritoneal dialysis catheter exit-site infection with signs of mild inflammation and growth of Staphylococcus aureus, but with no evidence of peritonitis.

Peritonitis and Exit-Site Infection in Pediatric Automated Peritoneal Dialysis

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 179-182
Author(s):  
Man-Chun Chiu ◽  
Pak-Chiu Tong ◽  
Wai-Ming Lai ◽  
Shing-Chi Lau
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Patient Specific ◽  
Coagulase Negative Staphylococcus ◽  
Site Infection ◽  
Automated Peritoneal Dialysis ◽  
Exit Site ◽  
Humid Climate ◽  
Exit Site Infection

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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