title: Exit site infections: systematic microbiologic and quality control are needed.
abstract: For the period January 2005 to June 2008, we reviewed the rates, causes, and outcomes of exit-site infection (ESI) among 137 consecutive patients [mean age: 51 +/- 16 years; 17 (12.4%) with diabetes; 76 (55%) on automated PD; time at risk: 240.41 dialysis years; mean follow-up: 20.4 +/- 13.8 months]. Treatment protocol included mini-laparotomy and Popovich-Moncrief placement method, with presurgical cefazolin prophylaxis and routine prescription of topical mupirocin for the exit site. Oral cotrimoxazole was the initial empirical ESI treatment. A total of 49 patients (36%) experienced 76 episodes of ESI, for a global incidence of 0.31 episodes per year at risk. Gram-positive organisms occurred in 56% of the cases, and gram-negative organisms in 27%. Staphylococcus aureus caused 15 ESIs (0.06 episodes/patient-year), and only 15% of gram-positive organisms were methicillin resistant. Methicillin-resistant S. aureus were all sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs (0.04 episodes/patient-year). Other Enterobacteriaceae occurred at a rate of 0.03 episodes/patient-year. Fungal ESLs occurred at a rate of 0.004 episodes/patient-year The ESI cure rate was 96%. In 3 patients, the catheter was removed, but only 2 patients (2.6%) experienced ESI-related peritonitis. Our unit's treatment policy and prophylactic use of exit-site mupirocin resulted in a low S. aureus ESI rate without an alarming incidence of gram-negative or Pseudomonas infections. Routine microbiologic and quality control is mandatory for strategies individualized to the dialysis center.
authors.affiliation: Department of Nephrology, Sant António General Hospital, Porto, Portugal. crislmf@yahoo.com.br
authors.forename: Cristina
authors.initials: C
authors.lastname: Freitas
authors.forename: Anabela
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Carvalho
authors.forename: António
authors.initials: A
authors.lastname: Cabrita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control* / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin