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July 20, 2020
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June 30, 2021
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Abstract

Objectives: To analyze the characteristics of catheter related exit-site infections, identifying the main related factors. Likewise, the effectiveness of a protocol based on the daily use of topical mupirocin in the exit site prophylaxis strategy has been compared with the use of saline solution.


Material and Method: Observational retrospective study. Demographic and clinical variables, the etiology and evolution of the episodes of infection of the orifice in a period of 2 years were collected. A prophylaxis protocol with saline solution and 2% mupirocin cream was used.


Results: We recruited 75 patients, mean age 60.3±13.9 years, 66.7% male, median time on peritoneal dialysis 24.3 months (interquartile range 11-48.7). The incidence of exit site infection was 26.7%, 77% were produced by skin and mucous microorganisms. The exit site infection was associated to Staphylococcus aureus nasal carriage (p=0.048) and the superficial cuff extrusion (p=0.004). 4 of the patients who presented peritonitis secondary to exit site infection, 3 were switch to hemodialysis (p=0.025). Daily topical antibiotic therapy protocol reduced the exit site infection rate by 68%.


Conclusions: The superficial cuff externalization is a predisposing factor for infections. Daily application of mupirocin is an effective strategy in reducing the incidence of exit site infections and peritonitis. The eradication of nasal carriers of Staphylococcus aureus can help reduce catheter loss and transfer to hemodialysis.


 

Keywords

peritoneal catheter peritoneal dialysis exit-site infection mupirocin peritonitis

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González-Sanchidrián S, Nacarino-Muriel M del C, García-Girón AM, Fernández-Vivas F, Pazos-Pacheco M del C, Gallego-Domínguez S. Analysis of peritoneal catheter exit-site infections. Effectiveness of a protocol based on daily topical mupirocin application. Enferm Nefrol [Internet]. 2021 [cited 2025 Apr 30];24(2):[about 11 p.]. Available from: https://www.enfermerianefrologica.com/revista/article/view/4383
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References

  1. Montenegro J, Correa R, Riella MC. Tratado de diálisis peritoneal. 2ª ed. España: Elsevier; 2016.
  2. Fariñas MC, García-Palomo JD, Gutiérrez-Cuadra M. Infecciones asociadas a los catéteres utilizados para la hemodiálisis y la diálisis peritoneal. Enferm Infecc Micribiol Clin 2008; 26(8):518-26. DOI: https://doi.org/10.1157/13127459
  3. Htay H, Johnson DW, Craig JC, Schena FP, Strippoli GF, Tong A et al. Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients. Cochrane Database Syst Rev 2019;31;5:CD004680. DOI: https://doi.org/10.1002/14651858.CD004680.pub3
  4. Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figuereido AE et al. ISPD catheter-related infection recomendations: 2017 update. Perit Dial Int 2017;37(2):141-54. DOI: https://doi.org/10.3747/pdi.2016.00120
  5. Bajo MA, Selgas R, Remón C, Arrieta J, Álvarez-Ude F, Arenas MD et al. Plan de calidad científico-técnica y de mejora continúa de calidad en diálisis peritoneal. Nefrología 2010;30(1):28-45.
  6. Portolés J, Sánchez E, Janeiro D, Montenegro J. Peritonitis e infecciones del catéter en la diálisis peritoneal. En; Nefrología al día. Sociedad Española de Nefrología. 2019 [Consultado 14 abr 2020]. Disponible en: https://www.nefrologiaaldia.org/es-articulo-peritonitis-e-infecciones-del-cateter-223.
  7. Murray PR, Rosenthal KS, Phaller MA. Medical Microbiology. 9th ed. Philadelphia. Elsevier; 2020.8. Bennett JE, Dollin R, Blaser MJ. Mandell, Douglas and Bennett´s. Principles and Practice of Infectious Diseases. 9th ed. Philadelphia. Elsevier 2019.
  8. Pérez-Fontan M, Rodríguez Carmona A, Rosales M, García-Falcón T, Valdés F. Incidence and clinical significance of nasal and pericatheter colonization by gram-negative bacteria among patients undergoing chronic peritoneal dialysis. Nephrol Dial Transplant 2002;17:118-22. DOI: https://doi.org/10.1093/ndt/17.1.118
  9. Ragupathi L, Reyna M. Case Report of Cryptococcus Albidus Peritonitis in a Peritoneal Dialysis Patient and a Review of the Literature. Perit Dial Int 2015;35(4):421-7. DOI: https://doi.org/10.3747/pdi.2013.00134
  10. Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Antimicrobial agents to prevent peritonitis in peritoneal dialysis: a systematic review of randomized controlled trials. Am J Kidney Dis 2004;44:591-603. DOI: https://doi.org/10.1016/S0272-6386(04)00941-2
  11. Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized controlled trials. J Am Soc Nephrol 2004;15:2735-46. DOI: https://doi.org/10.1097/01.ASN.0000141463.95561.79
  12. Tacconelli E, Carmeli Y, Aizer A, Ferreira G, Foreman MG, D’Agata EM. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 2003;37:1629-38. DOI: https://doi.org/10.1086/379715
  13. Xu G, Tu W, Xu C. Mupirocin for preventing exit-site infection and peritonitis in patients undergoing peritoneal dialysis. Nephrol Dial Transplant 2010;25:587-92. DOI: https://doi.org/10.1093/ndt/gfp411
  14. Lim CT, Wong KS, Foo MW. The impact of topical mupirocin on peritoneal dialysis infection in Singapore General Hospital. Nephrol Dial Transplant 2005;20:2202-6.16. Davenport A. Do topical antibiotics reduce exit-site infection rates and peritonitis episodes in peritoneal dialysis patients? The Pan Thames Renal Audit. J Nephrol 2012;25:819-24. DOI: https://doi.org/10.5301/jn.5000071
  15. Wong C, Luk IW, Ip M, You JH. Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis. Am J Infect Control 2014;42:412-6. DOI: https://doi.org/10.1016/j.ajic.2013.12.008
  16. Cavdar C, Saglam F, Sifil A, et al. Effect of once-a-week vs thrice-a-week application of mupirocin on methicillin and mupirocin resistance in peritoneal dialysis patients: three years of experiencie. Ren Fail 2008;30:417-22. DOI: https://doi.org/10.1080/08860220801964228
  17. Pérez-Fontan M, Rosales M, Rodriguez-Carmona, García-Falcón T, Valdés F. Mupirocin resistance after long-term use for Staphylococcus aureus colonization in patients undergoing chronic peritoneal dialysis. Am J Kidney Dis 2002;39:337-41. DOI: https://doi.org/10.1053/ajkd.2002.30553
  18. Originales González-Sanchidrián S et al. https://doi.org/10.37551/S2254-2884202101020. Al-Hwiesh AK, Abdful-Rahman IS, Muhanna Al FA, et al. Prevention of peritoneal catheter infections in Saudi peritoneal dialysis: The emergence of high-level mupirocin resistance. Int J Artif Organs 2013;36:473-83. DOI: https://doi.org/10.5301/ijao.5000207
  19. Lin J, Ye H, Li J, Qiu Y, Wu H, Yi C, Lu S, et al. Prevalence and risk factors of exit-site infection in incident peritoneal dialysis patients. Perit Dial Int 2020;40(2):164-70. DOI: https://doi.org/10.1177/0896860819886965
  20. Picó L, Picó L, Blaya L, Hernández MI, Serrano RM, Lillo A. Infección del orificio de salida y anillo externo del catéter peritoneal tratada mediante técnica de Friedrich. Enferm Nefrol 2013;16 uppl(1):15-33. DOI: https://doi.org/10.4321/S2254-28842013000500009
  21. Kirmizis D, Bowes E, Ansari B, Cairns H. Exit-site recolocation: a novel, straightforward technique for exit-site infections. Perit Dial Int 2019;39(4):350-5. DOI: https://doi.org/10.3747/pdi.2017.00214
  22. Sun ML, Zhang Y, Wang B, Ma TA, Jiang H, Hu SL et al. Randomized controlled trials for comparison of laparoscopic versus conventional open catheter placement in peritoneal dialysis patients: a meta-analysis. BMC Nephrol 2020;21(1):60. DOI: https://doi.org/10.1186/s12882-020-01724-w
  23. Nochaiwong S, Ruengorn C, Noppakun K, Panyathong S, Dandecha P, Sood MM et al. Comparative effectiveness of local application of chlorhexidine gluconate, muripocin ointment, and normal saline for the prevention of peritoneal dialyisis related-infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol. Trials 2019;20(1):754. DOI: https://doi.org/10.1186/s13063-019-3953-8
  24. Boudville N, Johnson DW, Zhao J, Bieber BA, Pisoni RL, Piraino B et al. Regional variation in the treatment and prevention of peritoneal dialysisrelated infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2019;34(12):2118-26. DOI: https://doi.org/10.1093/ndt/gfy204
  25. Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: a nationwide cohort study. PLoS One. 2019;14(6):e0218677. DOI: https://doi.org/10.1371/journal.pone.0218677
  26. Annigeri R, Conly J, Vas S, Dedier H, Prakashan KP, Bargman JM, et al. Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection. Perit Dial Int. 2001;21(6):554-9. DOI: https://doi.org/10.1177/089686080102100604
  27. Perl J, Fuller DS, Bieber BA, Boudville N, Kanjanabuch T, Ito Y, et al. Peritoneal dialysis-related infection rates and outcomes: results from the peritoneal dialysis outcomes and practice patterns study (PDOPPS). Am J Kidney Dis 2020. pii: S0272-6386(19)31105-9.
  28. Aguilera-Flórez AI, Sastre-López A, Linares-Fano B, Guerra-Ordoñez JR, Alonso-Rojo AC, Prieto-Velasco M. Análisis del tiempo de entrenamiento y su relación con los episodios de peritonitis. Enferm Nefrol. 2020 Ene-Mar;23(1):54-9. DOI: https://doi.org/10.37551/S2254-28842020006
  29. Crabtree JH, Shrestha BM, Chow KM, Figuereido AE, Povlsen JV, Wilkie M et al. Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int 2019;39(5):414-36. DOI: https://doi.org/10.3747/pdi.2018.00232

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