Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance

The authors reviewed the course of 56 peritoneal dialysis patients after renal transplantation to determine the influence of this mode of dialysis on the results of transplantation. Three subgroups were analyzed separately because of marked differences in results. Group 1 was a historical group of 13 diabetic and two nondiabetic recipients of cadaveric grafts transplanted before 1982 who received standard immunosuppression with steroids and azathioprine only, and antirejection therapy with steroids and/or antithymocytic globulin (ATG). In this group results were poor: only 100/o of grafts and 670/o of patients survived two years or more. Group 2, the current group of cadaveric recipients, consists of 11 diabetic and nine nondiabetic patients transplanted since 1982; these patients received standard immunosuppression with low-dose steroids, azathioprine, and a two-week course of prophylactic ATG beginning within one day of transplantation; rejection was treated with high doses of oral steroids. In this second group, results were good: 630/o of the grafts are functioning and 100% of patients have survived for up to two years. Group 3, consisting of 21 recipients of living donor kidneys, had excellent results with 1000/o graft and patient survival up to five years. Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused the 19 graft losses. In most patients the dialysis catheters were removed three weeks to three months after transplantation when renal function was stable. There were two minor complications and no infections related to the catheters. We conclude that: a) excellent transplant results can be achieved in peritoneal dialysis patients, most of whom are diabetic and receive cadaveric grafts, b) the peritoneal dialysis catheter is not a significant source of peritransplant morbidity and therefore c) peritoneal dialysis is appropriate for patients awaiting renal transplantation and should not bias against their selection for transplantation. The published literature on kidney transplantation in patients on peritoneal dialysis is sparse, suggesting that it is not, and perhaps should not be common practice to transplant these patients. This study and review of the literature was undertaken 1) to characterize peritoneal dialysis patients undergoing renal transplantation at our center, 2) to determine the results of transplantation in this group, 3) to evaluate the risk to these patients from the peritoneal dialysis catheter itself and 4) to compare our experience with the literature concerning renal transplantation of peritoneal dialysis patients.

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Cutaneous abscess related to peritoneal catheter tunnel infection

10.22541/au.163257007.77957119/v1 ◽

2021 ◽

Author(s):

Yoshihiro Nakamura ◽

Tsuyoshi Watanabe ◽

Naoho Takizawa ◽

Yoshiro Fujita

Keyword(s):

Peritoneal Dialysis ◽

Physical Examination ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Peritoneal Catheter ◽

Tunnel Infection ◽

Catheter Infections

Some peritoneal dialysis catheter infections cannot be detected via a physical examination. Ultrasonography can aid in the diagnosis of such infections.

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Continuous Ambulatory Peritoneal Dialysis Catheter Infections: Diagnosis and Management

Peritoneal Dialysis International ◽

10.1177/089686089401400310 ◽

1994 ◽

Vol 14 (3) ◽

pp. 248-254 ◽

Cited By ~ 33

Author(s):

Michael J. Flanigan ◽

Linda A. Hochstetler ◽

Donita Langholdt ◽

Victoria S. Lim

Keyword(s):

Peritoneal Dialysis ◽

Antibiotic Therapy ◽

Minimal Risk ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Gram Negative ◽

Home Dialysis ◽

Serous Discharge ◽

Catheter Infections

Purpose To develop diagnostic and treatment strategies for peritoneal dialysis catheter exit-site and tunnel infections. Population All consenting peritoneal dialysis patients performing home dialysis through the University of Iowa Hospitals and Clinics Home Dialysis Training Center. This is a state-owned teaching hospital serving a rural population of approximately one million people in Iowa and western Illinois. Methods Four dialysis nurses collected information on a prospectively designed data acquisition tool. Patients were randomly assigned to one of two treatment groups, intraperitoneal vancomycin plus oral rifampin or oral trimethoprim/ sulfamethoxazole (TMP/SMX), and their initial antibiotic therapy determined by that assignment. If the infection was gram -negative, the initial antibiotics were discontinued and an alternative therapy begun. Therapy was initiated by the nursing staff and required physician notification within 48 hours. Results There were 126 recorded catheter infections (exit-site, tunnel, or cuff infection) resulting in a rate of 0.67 episodes per patient year of exposure. Staphylococcus aureus was isolated from the majority (60%) of these events. Pseudomonas aeruginosa was the next most common isolate and accounted for 21% of infections. Rubor, dolor, and turgor are the classic signs of inflammation, and at least one of these was present in 79% of the episodes. Isolated pericatheter erythema or serous discharge was associated with a minimal risk «2%) of catheter loss. The presence of a purulent exit-site discharge identified patients who had a 30% chance of failing systemic antibiotic therapy and a 20% risk of catheter loss. The concurrent presence of exit-site tenderness or swelling identified the most severe infections. Staphylococcal infections responded equally well to local cleaning and vancomycin plus rifampin (86% cured) or oral trimethoprim/sulfamethoxazole (89% cured) therapy. Gram-negative infections were frequent (27%) and appeared to respond best to a combination of tobramycin and ciprofloxacin. Conclusion Exit-site/tunnel inflammation is detectable by patients and can be used to guide therapy. An isolated finding of erythema or serous discharge is not indicative of an acute infection and may not require systemic antibiotics. The presence of purulence identifies patients at risk for catheter loss, and these patients benefit from systemic therapy. The combination of a purulent exit-site discharge plus pericatheter tenderness or swelling identifies patients likely to suffer treatment failure and require subsequent catheter removal. The cure rate of gram -positive catheter infections treated with vancomycin plus rifampin was indistinguishable from that achieved with oral trimethoprim/sulfamethoxazole (p = 0.99).

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A surgical girdle postoperatively may prevent pain and tunnel infections of peritoneal dialysis patients

The International Journal of Artificial Organs ◽

10.1177/0391398819882439 ◽

2019 ◽

Vol 43 (4) ◽

pp. 225-228

Author(s):

Christina Nilsson ◽

Wolfgang Sperker ◽

Claudia Schien ◽

Malin Isaksson ◽

Bernd G Stegmayr

Keyword(s):

Abdominal Pain ◽

Peritoneal Dialysis ◽

Analogue Scale ◽

Exposure Period ◽

Acute Onset ◽

The Other ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Dialysis Patients ◽

Retrospective Questionnaire

Aim: When performing acute onset dialysis after insertion of catheters for peritoneal dialysis, pain exists and tunnel infections may develop. This study investigated whether patients benefit from the use of a surgical girdle and specific dressing postoperatively to prevent pain and tunnel infections. Materials and Methods: In 85 consecutive patients, the development of tunnel infections was followed. The patients used a surgical girdle when they were in supine position from day 1 to day 3. The peritoneal dialysis catheter was fixed in a curvature avoiding stretch in the exit. A total of 53 patients participated in a retrospective questionnaire to evaluate abdominal pain within the first 3 days after surgery either with or without girdle. A visual analogue scale from 0 to 10 was used. Results: In 23 patients, data on pain both with and without the girdle could be recorded. Pain was relieved more when using the girdle versus no girdle (median day 1 3.0 vs 4.0, p < 0.001, n = 30, Wilcoxon paired). The development of tunnel infections during the latest 7-year period (exposure period 1487 months) showed a total of three episodes (one every 495 months) of which one caused a subsequent peritonitis, while the other two resolved after antibiotic therapy. Peritonitis episodes appeared at a mean of 37-month interval. Conclusion: The use a surgical girdle for 3 days postoperatively and a fixation of the peritoneal dialysis catheter in a curved loop relieves the pain and results in few tunnel infections and subsequent episodes of peritonitis.

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Significance, Epidemiology, and Prevention of Peritoneal Dialysis Catheter Infections

Peritoneal Dialysis International ◽

10.1177/089686089601601s66 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 340-347 ◽

Cited By ~ 11

Author(s):

John M. Burkart

Keyword(s):

Patient Outcome ◽

Peritoneal Dialysis ◽

Preventive Measures ◽

Implantation Technique ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Catheter Design ◽

Intranasal Mupirocin ◽

Catheter Infections

Catheter infections are a major cause of morbidity, catheter loss, and transfer to hemodialysis. These infections are mainly due to S. aureus. To date, treatment is less than optimal. Therefore, the primary goal should be prevention of catheter infections. Prevention is based on improving catheter design and implantation technique while using careful exit-site care. Prophylaxis with antimicrobials such as intranasal mupirocin or the use of silverimpregnated catheters appears promising as a way to reduce the risk of developing S. aureus infections. To optimize patient outcome, one must focus on these preventive measures.

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After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?

The Journal of Vascular Access ◽

10.1177/1129729817751620 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 31-34

Author(s):

Hirotake Kasuga

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Dialysis Patients ◽

Peritoneal Equilibration Test ◽

Ultrafiltration Failure ◽

Refractory Peritonitis ◽

End Stage ◽

Peritoneal Function ◽

Dialysis Discontinuation

Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.

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