[The effect of nasal and skin colonization on the development of exit site and peritoneal catheter tunnel infections in patients on peritoneal dialysis].
ESI remain a major problem in patients undergoing peritoneal dialysis and are frequently the reason for catheter removal. The treatment is often costly and not effective and the need for routine prophylactics has to be clarified. In this study 38 peritoneal dialysis patients (15 F & 23 M, age: 18-73) were analysed prospectively for ESI and TI in respect to skin (exit site and inguinal area) and nostrils colonisation. There were 14 diabetics and 24 non-diabetics. All had standard double-cuff Tenckhoff catheter and none presented with ESI prior to the study. No treatment was applied on the basis of positive culture only. In 27 patients swab were repeated after 6-11 months. Eight episodes of ESI and three TI were recorded. Following pathogens were cultured: S.aureus in 4 Klebsiella pneumoniae in 2, Corynebacterium sp. in 1, negative in 1 and with TI S.aureus in 3. Positive nasal cultures (S.aureus, Klebs.pn.) were observed in 5 patients subsequently developing ESI (p < 0.01) and in 2 with TI. In 2 cases exit site was also colonized by pathogens responsible for ESI (p = NS). Inguinal area was colonized by various pathogens in 7 patients, but only one of these developed ESI (p = NS) and no one TI. There was no difference between diabetic and non-diabetics neither in the frequency of ESI, TI nor in nasal carriage of pathogens. In the majority of patients nostrils and inguinal area were colonized by S.epidermidis. When the second culture was analyzed it appeared that significantly more patients had exit site colonized by S.epidermidis (2 and 11 patients in 2 consecutive cultures respectively (p < 0.01). In conclusion, it appears that nasal carriers of pathogens like S.aureus and Klebsiella pneumoniae are more prone to ESI. Inguinal area and exit site colonization does not seem to precede ESI or TI. We would suggest that nasal carriage status should be routinely identified in all patients entering peritoneal dialysis programme and the carriers properly treated.
Klinika Chorób Nerek, Instytutu Chorób Wewnetrznych, Akademii Medycznej w Gdańsku.
M
M
Lichodziejewska-Niemierko
T
T
Liberek
M
M
Renke
B
B
Rutkowski
D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology* / Q000517:prevention & control* / Q000635:transmission; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004197:Disease Reservoirs; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*
Wpływ kolonizacji nosa i skóry na rozwój zapaleń ujścia i tunelu cewnika otrzewnowego u pacjentów dializowanych otrzewnowo.