Diagnosis and Management of Exit Site Infection in Peritoneal Dialysis Patients

Abstract

Exit site infection ESI is an important clinical problem in peritoneal dialysis PD patients and is a significant cause of peritonitis and catheter loss. While most ESIs are caused by skin commensals, rising incidence of atypical and resilient organisms such as mycobacteria, Pseudomonas and Burkholderia species has been observed. The diagnosis and management of these emerging pathogen remain difficult and poorly defined. This chapter highlights the evaluation and management of ESI in PD patients. The clinical features, microbiology, and ultrasonographic findings are discussed. The general and specific management of ESI due to different organisms will also be elaborated. ESI is usually a clinical diagnosis, but the use of bedside ultrasound can help assess for any collection around the cuff and tunnel tract involvement. Topical prophylaxis remains an effective way to prevent ESI. While the majority ESIs are related to skin flora and can be managed successfully by topical or systemic antimicrobials, clinicians should be alert to the emergence of resistant and atypical microorganisms. Surgical treatment should be reserved for ESI refractory to medical treatment or those with associated peritonitis.

Skin and soft tissue infections in hospitalized cancer patients

“… 1 Most of the exit site infections have been reported to be caused by skin flora and can be treated successfully by topical or systemic antimicrobials. 16 They can be prevented by using chlorhexidine-impregnated dressings and sponges and treated with topical antimicrobial agents based on culture results. 17 For example, mupirocin ointment is commonly used for treating Staphylococcus aureus infection and ketoconazole or lotrimin ointment for Candida infection.…”

“…1 Most of the exit site infections have been reported to be caused by skin flora and can be treated successfully by topical or systemic antimicrobials. 16 They can be prevented by using chlorhexidine-impregnated dressings and sponges and treated with topical antimicrobial agents based on culture results. 17 Staphylococcus aureus was the predominant pathogen in our study population, a finding similar to what has been reported in the United States and elsewhere.…”