Staphylococcus Aureus Peritoneal Catheter-Related Infections: A Cause of Catheter Loss and Peritonitis

Abstract

To determine the impact of Staphylococcus aureus catheter-related infections in a peritoneal dialysis program we reviewed all S. aureus catheter-related infections in our program over a six-year period. Twenty -five percent (51/204) of patients at risk developed S. aureus catheter exit-site or tunnel infections. S. aureus accounted for 61% of all positive exit-site cultures; of 320 catheters implemented, 65 were infected with S. aureus. Fifty-one S. aureus-infected patients were retrospectively matched with 51 noninfected patients from our peritoneal dialysis program. Patients with S. aureus catheter-related infections had significantly greater catheter loss from catheter infection and peritonitis. There was significantly more S. aureus peritonitis but less coagulase negative staphylococcus peritonitis in patients with S. aureus catheter-related infections. Significantly more noninfected control patients remained peritonitis free. During this period, 83% of all S. aureus peritonitis was associated with S. aureus catheter infections, and 28 of 57 replacement catheters were reinfected with S. aureus. These findings suggest S. aureus is a major catheter-related pathogen leading to catheter loss and peritonitis. The high recurrence rate suggests that host factors may predispose to S. aureus catheter-related infections.

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

“…Prophylactic intermittent administration of rifampicin has been limited due to the induction of antibiotic resistance by S. aureus. 34 Although the infection of the internal or external cuff is not infrequent, the infection around the cuff cannot be treated readily by antibiotic treatment. Thus, the catheter has to be removed in many cases, particularly if it is accompanied by peritonitis.…”

Exit‐site and catheter‐related infections in peritoneal dialysis: Problems and progress

“…aureus, are the major causes of catheter removal and technique failure in PD. [16][17][18] Staph. aureus therefore is known as the Achilles' heel of PD.…”

CAPD Peritonitis: A Critical Appraisal of Prophylactic Strategies

“…An exit site infection (ESI) could facilitate peritonitis by either of these routes. In one study, 83% of Staphylococcus aureus peritonitis episodes were reported to be preceded by a Staphylococcus aureus ESI (42). The probability of developing a purulent ESI was 35% during the first 12 months of CAPD, and among 39 patients with purulent ESI, 3 1 developed peritonitis.…”

“…Staphylococcus aureus infections also have a tendency to recur in individual patients. Zimmerman et al (42) found that 16 of 28 patients whose catheters had been removed for Staphylococcus aureus infection developed reinfection with Staphylococcus aureus in the replacement catheter. It has been suggested that host factors might be important in accounting for this high frequency of recurrence (43,44).…”