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Abstract
Introduction: Outflow tract infection is an important complication in peritoneal dialysis, mainly because it can progress to tunelitis and/or catheter-dependent peritoneal infection that often leads to catheter removal.
Objectives: To analyse the mupirocin application in the management of the healthy exit site and the impact on the infection rate and the percentage of catheter-dependent peritoneal infections.
Material and Method: Retrospective observational study in a provincial peritoneal dialysis unit. Patients over 18 years of age who underwent peritoneal dialysis at home from 01/01/2019 to 31/12/2021 were included. Variables analysed were: sex, yearly orifice infection rate, responsible germs, catheter-dependent peritoneal infections and appearance of resistance. Data were obtained from the unit’s annual registry.
Results:Twice-weekly mupirocin application in healthy peritoneal catheter exit site care has decreased the rate of exit site infections from 0.47 episode/patient/year in 2019 to 0.32 in 2020 and 0.16 in 2021, decreasing the percentage of catheter-dependent peritoneal infections from 38% in 2019 to 30% in 2020 and 8% in 2021. No resistance has been observed.
Conclusions: Mupirocin application in our unit appears to be effective in reducing exit site infections and catheter-dependent peritoneal infections.
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Copyright (c) 2022 MÓNICA FERNÁNDEZ PÉREZ, ADELA SUÁREZ ÁLVAREZ, FABIOLA MENÉNDEZ SERVIDE, JESSICA BLANCO SIERRA, MAGDALENA PASARÓN ALONSO, MIGUEL NÚÑEZ MORAL
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References
- Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo 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
- Pérez-Fontán M, Moreiras M, Prieto M, Quereda C, Bajo MA, Borràs M, et al. Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022;42(S1):S3-58. DOI: https://doi.org/10.1016/j.nefro.2021.10.007
- Benavides A, Vásquez I, Yacub LCA, Fuentes LEC, Zamora WD, Velandia LG, et al. Peritonitis en diálisis peritoneal continua ambulatoria Factores medioambientales y de autocuidado. Repertorio de Medicina y Cirugía 2005;14(2):88-100. DOI: https://doi.org/10.31260/RepertMedCir.v14.n2.2005.386
- Portolés Pérez J, Janeiro D, Montenegro Martínez J. Peritonitis e infecciones del catéter en la diálisis peritoneal. Nefrología al día 2019. [consultado 30 Ago 2022]. Disponible en: https://www.nefrologiaaldia.org/223.
- Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, et al. ISPD 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
- Pelaéz Requejo B, Fernández Pérez M, Núñez Moral M, González Díaz I, Méndez González A, Quintana Fernández A. Evaluación de los conocimientos prácticos de los pacientes prevalentes en diálisis peritoneal. Enferm Nefrol [Internet]. 24 de octubre de 2013 [consultado 5 de Sep 2022];16(3):179-84. Disponible en: https://www.enfermerianefrologica.com/revista/article/view/4196. DOI: https://doi.org/10.4321/S2254-28842013000300006
- Pérez-Fontán M, Rosales M, Rodríguez-Carmona A, Falcón TG, Valdés F. Mupirocin resistance after long-term use for Staphylococcus aureus colonization in patients undergoing chronic peritoneal dialysis. American journal of kidney diseases 2002;39(2):337-41. DOI: https://doi.org/10.1053/ajkd.2002.30553
- Annigeri R, Conly J, Vas SI, 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
- Núñez-Moral M, Sánchez-Álvarez E, González-Díaz I, Peláez-Requejo B, Fernández-Viña A, Quintana-Fernández A, et al. Exit-site infection of peritoneal catheter is reduced by the use of polyhexanide. Results of a prospective randomized trial. Peritoneal Dialysis International 2014;34(3):271-7. DOI: https://doi.org/10.3747/pdi.2012.00109
- Johnson DW, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, et al. Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. The Lancet Infectious Diseases 2014;14(1):23-30. DOI: https://doi.org/10.1016/S1473-3099(13)70258-5
- Núñez-Moral M. Incertidumbre durante la atención enfermera en el cuidado del orificio de salida sano del catéter peritoneal. Enferm Nefrol 2021;24(2):195-7. DOI: https://doi.org/10.37551/S2254-28842021018
- Obata Y, Murashima M, Toda N, Yamamoto S, Tsujimoto Y, Tsujimoto Y, et al. Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials. Ren Reemplazar Ther 2020 [consultado 12 Jun 2021] 6:12. Disponible en: https://doi.org/10.1186/s41100-020-00261-4. DOI: https://doi.org/10.1186/s41100-020-00261-4
- Bajo MA, Selgas R, Remón C, Arrieta J, Álvarez-Ude F, Arenas MD, et al. Plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal. Nefrologia 2010;30(1):28-45.
- Vallejo L. Siete errores comunes en el diagnóstico, manejo y tratamiento de heridas crónicas [Seven common errors in the diagnosis, management and treatment of chronic wounds]. J Wound Care. 2020 Jan 1;29(LatAm sup 1):S326. DOI: https://doi.org/10.12968/jowc.2020.29.LatAm_sup_1.32
- García-Fernández FP, Soldevilla-Ágreda JJ, Pancorbo- Hidalgo PL, Verdú-Soriano J, López-Casanova P, Rodríguez Palma M, et al. Manejo local de úlceras y heridas. Serie de documentos técnicos GNEAUPP nº III. Grupo Nacional para el Estudio y Asesoramiento de las Úlceras por Presión y Heridas Crónicas. Logroño. 2018.
- Riu S, Ruiz CG, Martinez-Vea A, Peralta C, Oliver JA. Spontaneous rupture of polyurethane peritoneal catheter. A possible deleterious effect of mupirocin ointment. Nephrol Dial Transplant 1998;13(7):1870-1. DOI: https://doi.org/10.1093/ndt/13.7.1870
- González-Sanchidrián S, Nacarino-Muriel MC, García-Girón AM, Fernández Vivas F, Pazos-Pacheco MC, Gallego-Domínguez S. Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina topica diaria. Enferm Nefrol 2021;24(2):163-73. DOI: https://doi.org/10.37551/S2254-28842021010
- Lobbedez T, Gardam M, Dedier H, Burdzy D, Chu M, Izatt S, et al. Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resistance: still low after 7 years. Nephrol Dial Transplant 2004;19(12):3140-3. DOI: https://doi.org/10.1093/ndt/gfh494
- Mahajan S, Tiwari SC, Kalra V, Bhowmik DM, Agarwal SK, Dash SC, et al. Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis population. Perit Dial Int 2005;25(5):473-7. DOI: https://doi.org/10.1177/089686080502500512
- Wong C, Luk IW, Ip M, You JH. Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis. American journal of infection control 2014;42(4):412-6. DOI: https://doi.org/10.1016/j.ajic.2013.12.008
- Aykut S, Caner C, Ozkan G, Ali C, Tugba A, Zeynep G, et al. Mupirocin application at the exit site in peritoneal dialysis patients: five years of experience. Renal failure 2010;32(3):356-61. DOI: https://doi.org/10.3109/08860221003611703
- Chu KH, Choy WY, Cheung CCW, Fung KS, Tang HL, Lee W, et al. A prospective study of the efficacy of local application of gentamicin versus mupirocin in the prevention of peritoneal dialysis catheter-related infections. Perit Dial Int 2008;28(5):505-8. DOI: https://doi.org/10.1177/089686080802800514
- Sánchez-Hernández J. El legado de George Evelyn Hutchinson en la ecología y limnología moderna. Boletín de la Real Sociedad Española de Historia Natural 2021;115:64-76.
References
Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo 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
Pérez-Fontán M, Moreiras M, Prieto M, Quereda C, Bajo MA, Borràs M, et al. Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022;42(S1):S3-58. DOI: https://doi.org/10.1016/j.nefro.2021.10.007
Benavides A, Vásquez I, Yacub LCA, Fuentes LEC, Zamora WD, Velandia LG, et al. Peritonitis en diálisis peritoneal continua ambulatoria Factores medioambientales y de autocuidado. Repertorio de Medicina y Cirugía 2005;14(2):88-100. DOI: https://doi.org/10.31260/RepertMedCir.v14.n2.2005.386
Portolés Pérez J, Janeiro D, Montenegro Martínez J. Peritonitis e infecciones del catéter en la diálisis peritoneal. Nefrología al día 2019. [consultado 30 Ago 2022]. Disponible en: https://www.nefrologiaaldia.org/223.
Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, et al. ISPD 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
Pelaéz Requejo B, Fernández Pérez M, Núñez Moral M, González Díaz I, Méndez González A, Quintana Fernández A. Evaluación de los conocimientos prácticos de los pacientes prevalentes en diálisis peritoneal. Enferm Nefrol [Internet]. 24 de octubre de 2013 [consultado 5 de Sep 2022];16(3):179-84. Disponible en: https://www.enfermerianefrologica.com/revista/article/view/4196. DOI: https://doi.org/10.4321/S2254-28842013000300006
Pérez-Fontán M, Rosales M, Rodríguez-Carmona A, Falcón TG, Valdés F. Mupirocin resistance after long-term use for Staphylococcus aureus colonization in patients undergoing chronic peritoneal dialysis. American journal of kidney diseases 2002;39(2):337-41. DOI: https://doi.org/10.1053/ajkd.2002.30553
Annigeri R, Conly J, Vas SI, 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
Núñez-Moral M, Sánchez-Álvarez E, González-Díaz I, Peláez-Requejo B, Fernández-Viña A, Quintana-Fernández A, et al. Exit-site infection of peritoneal catheter is reduced by the use of polyhexanide. Results of a prospective randomized trial. Peritoneal Dialysis International 2014;34(3):271-7. DOI: https://doi.org/10.3747/pdi.2012.00109
Johnson DW, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, et al. Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. The Lancet Infectious Diseases 2014;14(1):23-30. DOI: https://doi.org/10.1016/S1473-3099(13)70258-5
Núñez-Moral M. Incertidumbre durante la atención enfermera en el cuidado del orificio de salida sano del catéter peritoneal. Enferm Nefrol 2021;24(2):195-7. DOI: https://doi.org/10.37551/S2254-28842021018
Obata Y, Murashima M, Toda N, Yamamoto S, Tsujimoto Y, Tsujimoto Y, et al. Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials. Ren Reemplazar Ther 2020 [consultado 12 Jun 2021] 6:12. Disponible en: https://doi.org/10.1186/s41100-020-00261-4. DOI: https://doi.org/10.1186/s41100-020-00261-4
Bajo MA, Selgas R, Remón C, Arrieta J, Álvarez-Ude F, Arenas MD, et al. Plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal. Nefrologia 2010;30(1):28-45.
Vallejo L. Siete errores comunes en el diagnóstico, manejo y tratamiento de heridas crónicas [Seven common errors in the diagnosis, management and treatment of chronic wounds]. J Wound Care. 2020 Jan 1;29(LatAm sup 1):S326. DOI: https://doi.org/10.12968/jowc.2020.29.LatAm_sup_1.32
García-Fernández FP, Soldevilla-Ágreda JJ, Pancorbo- Hidalgo PL, Verdú-Soriano J, López-Casanova P, Rodríguez Palma M, et al. Manejo local de úlceras y heridas. Serie de documentos técnicos GNEAUPP nº III. Grupo Nacional para el Estudio y Asesoramiento de las Úlceras por Presión y Heridas Crónicas. Logroño. 2018.
Riu S, Ruiz CG, Martinez-Vea A, Peralta C, Oliver JA. Spontaneous rupture of polyurethane peritoneal catheter. A possible deleterious effect of mupirocin ointment. Nephrol Dial Transplant 1998;13(7):1870-1. DOI: https://doi.org/10.1093/ndt/13.7.1870
González-Sanchidrián S, Nacarino-Muriel MC, García-Girón AM, Fernández Vivas F, Pazos-Pacheco MC, Gallego-Domínguez S. Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina topica diaria. Enferm Nefrol 2021;24(2):163-73. DOI: https://doi.org/10.37551/S2254-28842021010
Lobbedez T, Gardam M, Dedier H, Burdzy D, Chu M, Izatt S, et al. Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resistance: still low after 7 years. Nephrol Dial Transplant 2004;19(12):3140-3. DOI: https://doi.org/10.1093/ndt/gfh494
Mahajan S, Tiwari SC, Kalra V, Bhowmik DM, Agarwal SK, Dash SC, et al. Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis population. Perit Dial Int 2005;25(5):473-7. DOI: https://doi.org/10.1177/089686080502500512
Wong C, Luk IW, Ip M, You JH. Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis. American journal of infection control 2014;42(4):412-6. DOI: https://doi.org/10.1016/j.ajic.2013.12.008
Aykut S, Caner C, Ozkan G, Ali C, Tugba A, Zeynep G, et al. Mupirocin application at the exit site in peritoneal dialysis patients: five years of experience. Renal failure 2010;32(3):356-61. DOI: https://doi.org/10.3109/08860221003611703
Chu KH, Choy WY, Cheung CCW, Fung KS, Tang HL, Lee W, et al. A prospective study of the efficacy of local application of gentamicin versus mupirocin in the prevention of peritoneal dialysis catheter-related infections. Perit Dial Int 2008;28(5):505-8. DOI: https://doi.org/10.1177/089686080802800514
Sánchez-Hernández J. El legado de George Evelyn Hutchinson en la ecología y limnología moderna. Boletín de la Real Sociedad Española de Historia Natural 2021;115:64-76.