Ultrasonography in the management of exit site infections in peritoneal dialysis patients

Kwan, Tze-Hoi; Tong, M.K.H.; Siu, Yui-Pong; Leung, Ken Cham Fai; Luk, S H; Cheung, Y. F.

doi:10.1111/j.1440-1797.2004.00331.x

Cited by 49 publications

(35 citation statements)

References 9 publications

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“…TI may present as erythema, oedema, or tenderness over the subcutaneous pathway, but is often clinically occult, as shown by sonographic studies 16,35 . Ultrasonography of the exit site is a useful adjunctive tool in the management of ESI and TI 16,36 . In this study population, ultrasonography showed the presence of pericatheteral TI.…”

Section: Discussionmentioning

confidence: 75%

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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Section: Discussionmentioning

confidence: 75%

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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“…We analyzed the influence of clinical findings on prognosis and found that exit-site infection and frequency of past peritonitis episodes were important factors. Ultrasonography can facilitate the diagnosis of exit-site infections [16]. For prevention of peritonitis from these infections, management issues, such as use of ultrasonography, antibiotic administration timing and duration, and timing of catheter replacement, should be considered.…”

Section: Discussionmentioning

confidence: 99%

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

et al. 2016

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Background: Peritonitis is the main cause of withdrawal from peritoneal dialysis (PD) therapy in Japan. The precise extent of PD-associated peritonitis in Japan has not been investigated since 2005; we aimed to clarify the recent incidence and prognosis of PD peritonitis. Methods: The 248 institutional members of the Japanese Society for Peritoneal Dialysis were surveyed by questionnaire regarding peritonitis episodes during January 1 to December 31, 2013. Results: Replies from 114 members were received regarding 3042 PD patients, including 516 peritonitis patients, covering a total observation period of 31,686 patient months. The incidence of peritonitis in this study was 0.195 episodes per year. Detailed data on 544 peritonitis episodes in 466 patients was obtained. The causes, in ranked order, were unknown reason, contamination at peritoneal fluid exchange, and extension of intra-abdominal cavity infection. Effluent culture methods included using a blood culture bottle (50.9 %), large-volume culture (culturing sediment after centrifuging effluent) (31.7 %), and direct culture of effluent using a culture dish (12.7 %). The rank order of microbes identified in peritoneal effluent cultures was culture-negative, Streptococcus sp. and Staphylococcus aureus. Empiric therapy with two kinds of antibiotics was administered to 406 cases (75.2 %), most commonly cefazolin + ceftazidime. Antibiotic administration methods included intraperitoneal (51.4 %), intravenous (46.4 %), and oral (2.2 %). After a peritonitis episode, 461 patients (84.7 %) continued PD therapy, 80 (14.7 %) withdrew from PD treatment, and 6 (1.1 %) died. Prognosis among patients grouped by antibiotic administration method was statistically significantly different; in the oral administration group, the rates of mortality and catheter replacement were higher. Logistic regression analysis showed that catheter exit-site infection and frequency of past peritonitis episodes were independent factors associated with PD treatment withdrawal. Conclusions: Although the overall incidence of PD peritonitis in Japan was relatively low, several areas for future improvement were identified: unknown reason and culture-negative were the most frequently cited causes of peritonitis; 1.1 % of patients died, and 13.6 % discontinued PD therapy. Improvements in effluent culture techniques, antibiotic administration methods, etiology determination, and patient education could help. A more effective protocol must be established to further improve the treatment of PD peritonitis in Japan.

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“…Involvement of the external cuff is associated with poor clinical outcomes (287). Shaving of the external cuff, followed by re-tunnelization, as an alternative to catheter removal for treatment of a persistent ESI has been proposed if the inner cuff is not involved.…”

Section: Guideline 19 -Treatment Of Catheter-related Infectionmentioning

confidence: 99%

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

et al. 2012

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Ultrasonography in the management of exit site infections in peritoneal dialysis patients

Cited by 49 publications

References 9 publications

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

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

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

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