Peritoneal Dialysis Exit-Site Care Protocols in Portugal and Its Association with Catheter-Related Infections

Abstract

<b><i>Introduction:</i></b> Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal. <b><i>Methods:</i></b> We performed a national survey using two questionnaires: one about the incidence of catheter-related infections and the other characterizing patients’ education and ES care protocols. <b><i>Results:</i></b> In 2017 and 2018, 14 Portuguese units followed 764 and 689 patients. ESi incidence rate was 0.41 episodes/year, and the peritonitis incidence rate was 0.37. All units monitor catheter-related infections on a yearly basis, use antibiotic prophylaxis at the time of catheter placement, and treat nasal carriage of <i>S. aureus</i>, although with different approaches. Screening for nasal carriage of <i>S. aureus</i> is performed by 12 units, and daily topical antibiotic cream is recommended by 6 out of 14 of the units. We did not find statistical differences in ESi/peritonitis, comparing these practices. The rate of ESis was lower with nonocclusive dressing immediately after catheter insertion, bathing without ES dressing, with the use of colostomy bags in beach baths and was higher with the use of bath sponge. The peritonitis rate was lower with bathing without ES dressing and if shaving of the external cuff was performed in the presence of chronic ESi. <b><i>Conclusions:</i></b> We found potential proceedings associated with ESi and peritonitis. A regular national audit of peritoneal dialysis units is an important tool for clarifying the best procedures for reduction of catheter-related infections.

ISPD Catheter-related Infection Recommendations: 2023 Update

“…17 Reported incidences of exit site infections have varied largely, ranging from 0.06 to 0.42 episodes per year. 13,[18][19][20][21][22][23][24] In the HON-EYPOT trial involving 371 PD patients from 26 centres in 3 countries (Australia, New Zealand and Singapore) between 2008 and 2012, the exit site infection rate was 0.29 episodes per year in the standard of care arm using mupirocin versus 0.37 episodes per year in the antibacterial honey arm. 22 However, the incidence rate of exit site infection is expected to be higher in real life than in the setting of randomised trial, where patient selection occurs.…”