Exit-site/tunnel infection and catheter outcome in peritoneal dialysis patients.
OBJECTIVE
To study exit-site/tunnel infections and catheter outcomes in peritoneal dialysis patients.


METHODS
The study was designed to investigate exit-site (ESI)/tunnel infections (TI) and catheter losses in all chronic PD catheters inserted in ESRD patients from 9/88 to 9/91.


METHODS
Tertiary-referral university hospital.


METHODS
Seventy-three patients (40 males, 33 females) underwent 78 double-cuff coiled swan-neck catheter implantations surgically. The curettage of exit site was performed weekly for tunnel infection refractory to medical management. The subcutaneous cuff was excised in persistent ESI/TI.


RESULTS
Fifty-nine episodes of ESI/TI in 34 patients were observed over 946 patient-months. Thirty-nine patients experienced no ESI/TI, 27 patients had one and seven had two or more episodes of ESI/TI. Four patients had five episodes of peritonitis associated with ESI/TI. Eight recurrent episodes of ESI/TI with S. aureus in 8 patients were treated successfully with Rifampin. Seven subcutaneous cuffs were excised successfully in 7 patients with tunnel infection, five with S. aureus and two with Pseudomonas aeruginosa. No catheter was removed due to ESI/TI or ESI/TI associated peritonitis.


CONCLUSIONS
Aggressive exit site care including repeated curettage, excision of the subcutaneous cuff and appropriate antibiotics reduced significantly catheter losses related to ESI/TI.
Dept. of Medicine, State University of New York, Stony Brook.
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Wadhwa
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Cabralda
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Suh
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Kvilekval
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Mason
D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*