Xerosis elevates the risk of catheter-related infections in peritoneal dialysis patients

Catheter-related infections, such as exit-site infection and tunnel infection, are major complications in peritoneal dialysis (PD) patients, affecting their prognosis. This study investigates the association between skin conditions and catheter-related infections.

Data from two distinct sources were analyzed: (1) 626 PD patients in the Korean arm of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) and (2) skin microbiome data from 76 dialysis patients at Soonchunhyang University Cheonan Hospital. The relationship between catheter-related infection and self-reported xerosis and pruritus severity was assessed by Cox regression. Risk factors for xerosis and pruritus were evaluated by logistic regression. Furthermore, we discovered the relationship between the severity of pruritus and the relative abundance of Staphylococcus aureus on the skin.

The risk of catheter-related infections in PD patients increased with xerosis (hazard ratio [HR], 2.71; 95% confidence interval [CI], 1.19-6.18) and pruritus (HR, 2.57; 95% CI, 1.27-5.22), particularly increasing the risk of S. aureus-associated catheter-related infections (xerosis: HR, 5.66; 95% CI, 1.97-16.30; pruritus: HR, 5.93; 95% CI, 2.18-16.15). The relative abundance of S. aureus was notably higher in patients with severe pruritus. Moreover, patients were more likely to exhibit severe xerosis if they owned pets, had higher serum creatinine levels, and elevated calcium-phosphorus product levels.

Xerosis and pruritus significantly increase the risk of catheter-related infections, especially those caused by S. aureus. Instead of relying solely on prophylactic antibiotics for infection prevention, this study highlights the need for new preventive strategies in PD patients, focusing specifically on effective skin management.