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Abstract
Introduction: The identification of the causative microorganism of infection at the peritoneal catheter exit site and the subsequent antibiogram will allow the establishment of appropriate antibiotic treatment aimed at avoiding complications.
Objective: To describe a new method used in sample collection for exit site culture, microbiological, epidemiological, and clinical results in patients on peritoneal dialysis.
Material and Method: We conducted a descriptive, retrospective, and cross-sectional study, in the Peritoneal Dialysis Unit of Complejo Asistencial Universitario de León (Spain), over a period of 18 years. Adult patients with peritoneal catheters, with equivocal/infected exit sites, and sample collection for culture in pediatric blood culture bottles were included. Sociodemographic variables, catheter dwell time, microorganisms, episodes, peritonitis, and technique cost were collected.
Results: A total of 331 patients were studied, with a mean catheter dwell time of 37.44±107.06. Culture was collected from 171 patients, with 385 positive culture samples. A total of 63% were men, with a mean age of 59.66±16.35 years. A total of 465 microorganisms were identified, with 63 mixed cultures. Gram-positive bacteria, 365; Gram-negative, 86; Yeasts, 14. Peritonitis associated with the microorganism isolated at the exit site 41 resulted in 22 catheter removals.
Conclusions: This method has proven to be effective in identifying microorganisms. The most frequent: S. epidermidis and Corynebacterium spp, highlighting C. amycolatum with a multi-resistance profile and a tendency to create biofilm. Although this method is more expensive, promoting the recovery of slow-growing microorganisms, avoiding sample handling and contamination, as well as false negatives in patients on antibiotic therapy.
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Copyright (c) 2025 Ana Isabel Aguilera-Flórez, Mario Prieto-Velasco, Juan Ramón Guerra-Ordoñez, Lydia Rodríguez-Pérez, Elena María Castrillo-Cineira, Isabel Fernández-Natal
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References
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- ISPD Guidelines-International Society for Peritoneal Dialysis. [consultado 14 Jul 2024]. Disponible en: https://ispd.org/guidelines/.
- Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. Perit Dial Int 1996;16(Suppl 3):S32–50. DOI: https://doi.org/10.1177/089686089601603S02
- Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, Iet al. ISPD Catheter-Related Infection Recommendations: 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, Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrología 2022;42(S1):3–58. DOI: https://doi.org/10.1016/j.nefro.2021.10.007
- BD Bactec FX manual de usuario. https://es.slideshare.net/slideshow/bd-bactec-fx-manual-de-usuario/138098860
- Twardowski ZJ, Prowant BF. Exit-site study methods and results. Perit Dial Int. 1996;16 Suppl 3:S6-31. DOI: https://doi.org/10.1177/089686089601603S01
- González-Sanchidrián Silvia, Nacarino-Muriel María del Carmen, García-Girón Ana María, Fernández-Vivas Fidel, Pazos-Pacheco María del Carmen, Gallego-Domínguez Sandra. Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina tópica diaria. Enferm Nefrol. 2021;24(2):163-73. DOI: https://doi.org/10.37551/S2254-28842021010
- Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms. 2023;11(6):1614. DOI: https://doi.org/10.3390/microorganisms11061614
- Lasa I., Pozo J. L. del, Penadés J. R., Leiva J.. Biofilms bacterianos e infección. Anales Sis San Navarra [Internet]. 2005 [consultado 2025 Ene 22];28(2):163-75. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272005000300002&lng=es. DOI: https://doi.org/10.4321/S1137-66272005000300002
- Wong SS, Lau WY, Chan PK, Wan CK y Cheng YL. Bloqueo de antibióticos en el catéter Tenckhoff para la peritonitis asociada a la biopelícula. Perit Dial Int. 2017;37(4):475-7. DOI: https://doi.org/10.3747/pdi.2016.00252
- Aresté-Fosalba Nuria, Ramírez-López Miguel Ángel, Gómez-Castilla Antonia Concepción, Salgueira-Lazo Mercedes. Taurolidina como tratamiento adyuvante en casos de peritonitis recidivante en pacientes en diálisis peritoneal. Nefrologia. 2020;40(2):115-212. DOI: https://doi.org/10.1016/j.nefro.2019.03.014
- Lin J, Ye H, Li J et al. Prevalencia y factores de riesgo de infección por el sitio de salida en pacientes de diálisis peritoneal incidente. Diálisis Peritoneal Internacional. 2020;40(2):164-70. DOI: https://doi.org/10.1177/0896860819886965
- Santos C, Pérez-Fontán M, Rodríguez-Carmona A, Calvo-Rodríguez M, López-Muñiz A, López-Calviño B, García-Falcón T. Identificación de objetivos para la prevención del túnel del catéter peritoneal y las infecciones del sitio de salida en entornos de baja incidencia. Perit Dial Int. 2016;36(1):43-51. DOI: https://doi.org/10.3747/pdi.2014.00131
- Bieber S, Mehrotra R. Peritoneal Dialysis Access Associated Infections. Adv Chronic Kidney Dis. 2019;26(1):23-9. DOI: https://doi.org/10.1053/j.ackd.2018.09.002
- 16. Lloyd A, Tangri N, Shafer LA, Rigatto C, Perl J, Komenda P, et al. The risk of peritonitis after an exit site infection: a time-matched, case-control study. Nephrol Dial Transplant. 2013;28:1915–21. DOI: https://doi.org/10.1093/ndt/gft002
- Li PK-T, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International. 2022;42(2):110-53. DOI: https://doi.org/10.1177/08968608221080586
- Gołembiewska E, Ciechanowski K. Repeat exit site infection in peritoneal dialysis patient with polycythemia vera - a case report. BMC Infect Dis. 2021;21(1):624. DOI: https://doi.org/10.1186/s12879-021-06342-x
- Portolés Pérez J, García E, Janeiro D, Sánchez Álvarez JE. Peritonitis asociada a diálisis peritoneal. En: Lorenzo V, López Gómez JM (Eds). Nefrología al día. ISSN: 2659-2606. 2023. [consultado 02 Nov 2024]. Disponible en: https://www.nefrologiaaldia.org/560
- Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, Piraino B. Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol. 2005;16(2):539-45. DOI: https://doi.org/10.1681/ASN.2004090773
- Van Diepen AT, Tomlinson GA, Jassal SV. The association between exit site infection and subsequent peritonitis among peritoneal dialysis patients. Clin J Am Soc Nephrol. 2012;7(8):1266-71. DOI: https://doi.org/10.2215/CJN.00980112
- Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012;1(4):106-22. DOI: https://doi.org/10.5527/wjn.v1.i4.106
- Muthucumarana K, Howson P, Crawford D, Burrows S, Swaminathan R, Irish A.The relationship between presentation and the time of initial administration of antibiotics with outcomes of peritonitis in peritoneal dialysis patients: the PROMPT study. Kidney Int Rep. 2016;1(2):65-72. DOI: https://doi.org/10.1016/j.ekir.2016.05.003
- Oki R, Tsuji S, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, et al. Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis. Sci Rep. 2021;11(1):6547. DOI: https://doi.org/10.1038/s41598-021-86071-y
- Laboratorios Britania. Hemocultivos. [consultado 23 Ene 2025]. Disponible en: http://www.britanialab.com
References
Chow KM, Li PK, Cho Y, Abu-Alfa A, Bavanandan S, Brown EA, et al. ISPD Catheter-related Infection Recommendations: 2023 Update. Perit Dial Int. 2023;43(3):201-19. DOI: https://doi.org/10.1177/08968608231172740
ISPD Guidelines-International Society for Peritoneal Dialysis. [consultado 14 Jul 2024]. Disponible en: https://ispd.org/guidelines/.
Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. Perit Dial Int 1996;16(Suppl 3):S32–50. DOI: https://doi.org/10.1177/089686089601603S02
Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, Iet al. ISPD Catheter-Related Infection Recommendations: 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, Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrología 2022;42(S1):3–58. DOI: https://doi.org/10.1016/j.nefro.2021.10.007
BD Bactec FX manual de usuario. https://es.slideshare.net/slideshow/bd-bactec-fx-manual-de-usuario/138098860
Twardowski ZJ, Prowant BF. Exit-site study methods and results. Perit Dial Int. 1996;16 Suppl 3:S6-31. DOI: https://doi.org/10.1177/089686089601603S01
González-Sanchidrián Silvia, Nacarino-Muriel María del Carmen, García-Girón Ana María, Fernández-Vivas Fidel, Pazos-Pacheco María del Carmen, Gallego-Domínguez Sandra. Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina tópica diaria. Enferm Nefrol. 2021;24(2):163-73. DOI: https://doi.org/10.37551/S2254-28842021010
Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms. 2023;11(6):1614. DOI: https://doi.org/10.3390/microorganisms11061614
Lasa I., Pozo J. L. del, Penadés J. R., Leiva J.. Biofilms bacterianos e infección. Anales Sis San Navarra [Internet]. 2005 [consultado 2025 Ene 22];28(2):163-75. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272005000300002&lng=es. DOI: https://doi.org/10.4321/S1137-66272005000300002
Wong SS, Lau WY, Chan PK, Wan CK y Cheng YL. Bloqueo de antibióticos en el catéter Tenckhoff para la peritonitis asociada a la biopelícula. Perit Dial Int. 2017;37(4):475-7. DOI: https://doi.org/10.3747/pdi.2016.00252
Aresté-Fosalba Nuria, Ramírez-López Miguel Ángel, Gómez-Castilla Antonia Concepción, Salgueira-Lazo Mercedes. Taurolidina como tratamiento adyuvante en casos de peritonitis recidivante en pacientes en diálisis peritoneal. Nefrologia. 2020;40(2):115-212. DOI: https://doi.org/10.1016/j.nefro.2019.03.014
Lin J, Ye H, Li J et al. Prevalencia y factores de riesgo de infección por el sitio de salida en pacientes de diálisis peritoneal incidente. Diálisis Peritoneal Internacional. 2020;40(2):164-70. DOI: https://doi.org/10.1177/0896860819886965
Santos C, Pérez-Fontán M, Rodríguez-Carmona A, Calvo-Rodríguez M, López-Muñiz A, López-Calviño B, García-Falcón T. Identificación de objetivos para la prevención del túnel del catéter peritoneal y las infecciones del sitio de salida en entornos de baja incidencia. Perit Dial Int. 2016;36(1):43-51. DOI: https://doi.org/10.3747/pdi.2014.00131
Bieber S, Mehrotra R. Peritoneal Dialysis Access Associated Infections. Adv Chronic Kidney Dis. 2019;26(1):23-9. DOI: https://doi.org/10.1053/j.ackd.2018.09.002
16. Lloyd A, Tangri N, Shafer LA, Rigatto C, Perl J, Komenda P, et al. The risk of peritonitis after an exit site infection: a time-matched, case-control study. Nephrol Dial Transplant. 2013;28:1915–21. DOI: https://doi.org/10.1093/ndt/gft002
Li PK-T, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International. 2022;42(2):110-53. DOI: https://doi.org/10.1177/08968608221080586
Gołembiewska E, Ciechanowski K. Repeat exit site infection in peritoneal dialysis patient with polycythemia vera - a case report. BMC Infect Dis. 2021;21(1):624. DOI: https://doi.org/10.1186/s12879-021-06342-x
Portolés Pérez J, García E, Janeiro D, Sánchez Álvarez JE. Peritonitis asociada a diálisis peritoneal. En: Lorenzo V, López Gómez JM (Eds). Nefrología al día. ISSN: 2659-2606. 2023. [consultado 02 Nov 2024]. Disponible en: https://www.nefrologiaaldia.org/560
Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, Piraino B. Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol. 2005;16(2):539-45. DOI: https://doi.org/10.1681/ASN.2004090773
Van Diepen AT, Tomlinson GA, Jassal SV. The association between exit site infection and subsequent peritonitis among peritoneal dialysis patients. Clin J Am Soc Nephrol. 2012;7(8):1266-71. DOI: https://doi.org/10.2215/CJN.00980112
Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012;1(4):106-22. DOI: https://doi.org/10.5527/wjn.v1.i4.106
Muthucumarana K, Howson P, Crawford D, Burrows S, Swaminathan R, Irish A.The relationship between presentation and the time of initial administration of antibiotics with outcomes of peritonitis in peritoneal dialysis patients: the PROMPT study. Kidney Int Rep. 2016;1(2):65-72. DOI: https://doi.org/10.1016/j.ekir.2016.05.003
Oki R, Tsuji S, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, et al. Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis. Sci Rep. 2021;11(1):6547. DOI: https://doi.org/10.1038/s41598-021-86071-y
Laboratorios Britania. Hemocultivos. [consultado 23 Ene 2025]. Disponible en: http://www.britanialab.com