Pseudomonas Exit-Site Infections in CAPD Patients: Evolution and Outcome of Treatment

Lo, Chen‐Tsyr; Chu, Wai Ling; Wan, Kit Mui; Ng, Suk Yi; Lee, Wai Ling; Chu, Mui Fun; Cheng, Suk Wai; Lo, Wai Kei

doi:10.1177/089686089801800612

Cited by 22 publications

(15 citation statements)

References 8 publications

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“…Our retrospective analysis suggests that there is no additional benefit of topical gentamicin cream used in conjunction with systemic antibiotics in patients with Pseudomonas ESI. The overall cure rate of 50% in our population was similar to previously reported cure rates [ 3 , 4 ]. There are probably several factors that contribute to the low efficacy of topical gentamicin in Pseudomonas ESI compared with its ability to prevent Pseudomonas ESI.…”

Section: Discussionsupporting

confidence: 91%

Pseudomonasexit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics

et al. 2015

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BackgroundAlthough, Pseudomonas exit-site infection (ESI) is recognized as a major complication of peritoneal dialysis (PD) with high risk of catheter loss due to refractory/recurrent infection or peritonitis, there is remarkably little literature about treatment outcomes. International Society for Peritoneal Dialysis guidelines advise the use of one to two antibiotics; in addition, we change standard exit-site care by stopping prophylactic mupirocin and starting regular use of gentamicin 1% cream.MethodsRetrospective review of outcomes of Pseudomonas ESI from January 2012 to March 2015.ResultsDuring the study period, a total of 135 patients were on PD with an overall incidence of any ESI of 0.36/patient-year. There were 14 patients with ESI episodes with Pseudomonas with a rate of 0.12/patient-year. In total, 13 of 14 patients with ESI episodes were treated with oral ciprofloxacin and/or intraperitoneal (IP) gentamicin or ceftazidime, plus topical gentamicin, with a success rate of 38% (5/13). One patient had gentamicin-resistant Pseudomonas species and was treated successfully with topical polymyxin/bacitracin cream. Median follow-up time in cured patients was 385 days (range 74–1107). Six patients had associated with Pseudomonas peritonitis, four during follow-up and two at initial presentation. Three patients had recurrent ESI with Pseudomonas, with one successfully re-treated with topical and IP gentamicin. In total, in only 50% of the patients was Pseudomonas ESI successfully treated. Five of the patients (36%) changed modality to permanent haemodialysis following catheter removal.ConclusionEradication of Pseudomonas ESI remains difficult even with the addition of topical gentamicin to the exit site. There should be a low threshold for catheter replacement.

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Section: Discussionsupporting

confidence: 91%

Pseudomonasexit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics

et al. 2015

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“…In the case of P. aeruginosa-induced ESI unresponsive to antibiotic treatment and catheter shaving, catheter removal was recommended as soon as possible, since peritonitis caused by P. aeruginosa is accompanied frequently by technical failure. 32 There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa and ESI caused by S. aureus. Catheter revision may be an alternative method to save the catheter, although ESI by P. aeruginosa requires close observation for the potential for further aggressive therapy.…”

Section: Discussionmentioning

confidence: 84%

“…Exit site infection by P. aeruginosa requires attention due to the intractability in the elimination process of the pathogen. In the case of P. aeruginosa ‐induced ESI unresponsive to antibiotic treatment and catheter shaving, catheter removal was recommended as soon as possible, since peritonitis caused by P. aeruginosa is accompanied frequently by technical failure 32 . There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa and ESI caused by S. aureus .…”

Section: Discussionmentioning

confidence: 99%

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

Cho

Park

et al. 2012

Nephrology

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: Aim: Catheter‐related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal. Methods: We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed. Results: The total PD duration of all patients was 32 581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient‐months (0.12/patient‐year). The most common causative organism was methicillin‐sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin‐resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S. aureus (6/21, 28.6%). Conclusion: Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.

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“…The overall cure rate of 85% in our population was better than previously reported cure rates with different treatment methods. 22 – 24 Therefore, subcutaneous gentamicin injection around the cuff is feasible for eradicating resistant ESI, as evidenced by the low incidence of recurrence of ESI after the procedure. Only one of thirteen patients had developed a recurrence of ESI within the follow-up duration.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study

Dizdar

Ozer²,

Erdem³

et al. 2017

TCRM

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Background/purposeOne of the most common complications of the peritoneal dialysis (PD) is the infection of the exit site of the peritoneal catheter. The aim of the present study was to evaluate the efficacy of the subcutaneous gentamicin injection around the cuff as a part of routine treatment of the resistant exit site infection (ESI).MethodsIf the exit site remains infected after a 2-week systemic antibiotics treatment, it is defined as resistant ESI. In these cases, systemic antibiotics were discontinued and a subcutaneous 40-mg gentamicin injection was administered around the external cuff of the PD catheter every 3 days. A total of three or four injections were given to each patient.ResultsA subcutaneous gentamicin injection was administered around the cuff in thirteen patients for the treatment of resistant ESI over a 2-year period. The median follow-up time in cured patients was 12 months. Eleven of the thirteen patients had been apparently cured of their resistant ESI, with no recurrence. None of the patients had a gentamicin-resistant species. Subcutaneous gentamicin-related adverse effect was not observed in any patient.ConclusionSubcutaneous gentamicin injection around the cuff is a well-tolerated and effective strategy for treating resistant ESI. To gain widespread approval of this therapy and reach a consensus about ESI management, additional studies are needed.

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Pseudomonas Exit-Site Infections in CAPD Patients: Evolution and Outcome of Treatment

Cited by 22 publications

References 8 publications

Pseudomonasexit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics

Pseudomonasexit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics

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

Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study

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