Exit site infections: systematic microbiologic and quality control are needed.

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Exit-site infection (ESI) is a common complication in patients undergoing peritoneal dialysis (PD).
• Effective strategies are needed to reduce ESI rates and associated morbidity.

Purpose of the Study:

• To review the incidence, causes, and outcomes of exit-site infections (ESI) in PD patients.
• To evaluate the effectiveness of a specific treatment protocol including prophylactic mupirocin and empirical cotrimoxazole therapy.

Main Methods:

• Retrospective review of 137 PD patients from January 2005 to June 2008.
• Analysis of ESI episodes, causative organisms, treatment outcomes, and complications.
• Standardized treatment protocol: mini-laparotomy, Popovich-Moncrief catheter placement, cefazolin prophylaxis, topical mupirocin, and oral cotrimoxazole for empirical treatment.

Main Results:

• Global ESI incidence was 0.31 episodes per year at risk (76 episodes in 49 patients).
• Gram-positive organisms accounted for 56% of ESIs; Staphylococcus aureus was the most common (0.06 episodes/patient-year).
• Methicillin-resistant S. aureus (MRSA) was infrequent (15% of gram-positive isolates) and sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs.
• High ESI cure rate (96%); low rates of catheter removal (2.6%) and ESI-related peritonitis (2.6%).

Conclusions:

• The implemented treatment policy, including prophylactic exit-site mupirocin, effectively reduced Staphylococcus aureus ESI rates.
• The incidence of gram-negative and Pseudomonas infections remained low.
• Routine microbiologic surveillance and individualized strategies are crucial for managing ESIs in PD centers.