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Clinical significance of exit-site infections due to Xanthomonas in CAPD patients: a comparison with Pseudomonas
F Dapena1, R Selgas, A Garcia-Perea
1Servicio de Nefrologia, Hospital la Paz, Madrid, Spain.
Abstract:
We have assessed the clinical significance of exit-site infections secondary to Xanthomonas maltophilia in continuous ambulatory peritoneal dialysis (CAPD) patients, and compared them with episodes due to Pseudomonas. The study was a retrospective survey of all episodes of Xanthomonas and Pseudomonas-related exit-site infections (ESI) in all patients treated in our unit between 1984 and 1992. Thirteen episodes of Xanthomonas-related ESI were observed in eight patients and 17 episodes of Pseudomonas-related ESI were seen in 15 patients. Xanthomonas-related ESI was frequently associated with other microorganisms, while Pseudomonas-related ESI was not (66% versus 5%, P < 0.02). Only one episode of Xanthomonas-related ESI resulted in peritonitis and subsequent catheter removal, after 15 months of resistant colonization. Another case was considered to be chronic and indolent, as the Xanthomonas-related ESI continued after 23 months of local treatment. The other 11 episodes were resolved either without treatment or with an antibiotic cream after 7-120 days. However, all but two episodes of Pseudomonas-related ESI required intravenous antibiotics (usually ceftazidime); seven patients developed peritonitis, and 11 required surgical catheter manipulation (five external cuff extrusion, and six catheter removal) (1/13 Xanthomonas-related versus 11/17 Pseudomonas-related ESI, P < 0.03). Most Xanthomonas-related ESI do not lead to peritonitis, and constitute a mild condition, easily treatable without parenteral antibiotics or catheter replacement. The appearance of other associated organisms and the favourable evolution with local treatment suggest a saprophytic behaviour for Xanthomonas in our CAPD patients. On the contrary, Pseudomonas-related ESI is usually severe, requires parenteral antibiotics, frequently leads to peritonitis, and requires catheter replacement.
Insights
Xanthomonas maltophilia exit-site infections in continuous ambulatory peritoneal dialysis (CAPD) patients are typically mild and treatable with local antibiotics. Pseudomonas infections are more severe, often requiring intravenous antibiotics and catheter replacement.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Exit-site infections (ESI) are a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Identifying the causative microorganisms and their clinical significance is crucial for effective management and patient outcomes.
Purpose of the Study:
- To assess the clinical significance of exit-site infections caused by Xanthomonas maltophilia in CAPD patients.
- To compare Xanthomonas maltophilia ESI with those caused by Pseudomonas.
Main Methods:
- A retrospective survey of all Xanthomonas and Pseudomonas-related ESI episodes in CAPD patients treated between 1984 and 1992.
- Analysis of infection characteristics, treatment modalities, and patient outcomes.
Main Results:
- Thirteen episodes of Xanthomonas ESI occurred in eight patients; 17 episodes of Pseudomonas ESI occurred in 15 patients.
- Xanthomonas ESI were often polymicrobial (66%) and usually resolved with local treatment or no antibiotics (11/13 episodes).
- Pseudomonas ESI frequently required intravenous antibiotics (15/17 episodes), led to peritonitis (7/17), and necessitated catheter manipulation or removal (11/17).
Conclusions:
- Xanthomonas maltophilia ESI in CAPD patients generally represent a mild condition, rarely leading to peritonitis and often manageable with topical therapy.
- Pseudomonas ESI are typically more severe, posing a significant risk for peritonitis and requiring aggressive treatment, including parenteral antibiotics and catheter intervention.