Do topical antibiotics reduce exit site infection rates and peritonitis episodes in peritoneal dialysis patients? The Pan Thames Renal Audit

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.

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The Association between Exit Site Infection and Subsequent Peritonitis among Peritoneal Dialysis Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.00980112 ◽

2012 ◽

Vol 7 (8) ◽

pp. 1266-1271 ◽

Cited By ~ 51

Author(s):

Anouk T.N. van Diepen ◽

George A. Tomlinson ◽

Sarbjit V. Jassal

Keyword(s):

Peritoneal Dialysis ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s140894 ◽

2017 ◽

Vol Volume 13 ◽

pp. 909-914 ◽

Cited By ~ 1

Author(s):

Oguzhan Dizdar ◽

Ozerhan Ozer ◽

Selahattin Erdem ◽

Ali Ihsan Gunal

Keyword(s):

Peritoneal Dialysis ◽

Pilot Study ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site

Peritoneal Dialysis International ◽

10.1177/089686080302302s32 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 153-158 ◽

Cited By ~ 34

Author(s):

Sunny S.H. Wong ◽

Kwok Hong Chu ◽

Au Cheuk ◽

Wai Kay Tsang ◽

Samuel K.S. Fung ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Local Application ◽

Diabetic Patients ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Gram Positive ◽

Exit Site Infection ◽

Mupirocin Ointment

Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.

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Comparison of exit site infection and peritonitis incidences between povidone-iodine and normal saline use for chronic exit site care in peritoneal dialysis patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2014.05.030 ◽

2014 ◽

Vol 33 (3) ◽

pp. 144-149 ◽

Cited By ~ 7

Author(s):

Su Mi Lee ◽

Hwa Seong Nam ◽

Eu Gene Jeong ◽

Young Ki Son ◽

Seong Eun Kim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Normal Saline ◽

Povidone Iodine ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

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Pseudomonas exit site infections in continuous ambulatory peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v2101498 ◽

1992 ◽

Vol 2 (10) ◽

pp. 1498-1501

Author(s):

H R Kazmi ◽

F D Raffone ◽

A S Kliger ◽

F O Finkelstein

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Catheter Removal ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection ◽

Retrospective View ◽

History Of ◽

Oral Ciprofloxacin

The purpose of this study is to examine the natural history of Pseudomonas aeruginosa exit site infections in continuous ambulatory peritoneal dialysis (CAPD) patients treated with oral ciprofloxacin and local exit site care. A retrospective view was undertaken of 18 episodes of P. aeruginosa exit site infections developing in 17 patients maintained on CAPD during 1989 and 1990. Standardized therapy for the exit site infection consisted of oral ciprofloxacin (500 mg twice daily) and local exit site care with antiseptic agents. Fifteen (83%) of 18 of the pseudomonas exit site infections resolved with therapy. Three episodes (17%) required catheter removal to successfully eradicate the infection. Four of the 15 patients whose exit site infections resolved developed P. aeruginosa peritonitis 2 to 9 months after the clinical resolution of the exit site infection. The majority of pseudomonas exit site infections in CAPD patients can be successfully treated with oral ciprofloxacin and local care. Approximately 17% of the patients in this study required catheter removal to successfully eradicate the infection and an additional 22% of the patients developed pseudomonas peritonitis several months after the resolution of the exit site infection.

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