title: Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings.
abstract: ♦
  
  
  BACKGROUND
  Peritoneal catheter tunnel and exit-site infection (TESI) complicates the clinical course of peritoneal dialysis (PD) patients. Adherence to recommendations for catheter insertion, exit-site care, and management of Staphylococcus aureus (SAu) carriage reduces, but does not abrogate the risk of these infections. ♦
  
  
  OBJECTIVE
  To reappraise the risk profile for TESI in an experienced center with a long-term focus on management of SAu carriage and a low incidence of these infections. ♦
  
  
  METHODS
  Following a retrospective, observational design, we investigated 665 patients incident on PD. The main study variable was survival to the first episode of TESI. We considered selected demographic, clinical, and technical variables, applying multivariate strategies of analysis. ♦
  
  
  RESULTS
  The overall incidence of TESI was 1 episode/68.5 patient-months. Staphylococcus aureus carriage disclosed at inception of PD (but not if observed sporadically during follow-up) (hazard ratio [HR] 1.53, p = 0.009), PD started shortly after catheter insertion (HR 0.98 per day, p = 0.011), PD after kidney transplant failure (HR 2.18, p = 0.017), lower hemoglobin levels (HR 0.88 per g/dL, p = 0.013) and fast peritoneal transport rates (HR 2.92, p = 0.03) portended an increased risk of TESI. Delaying PD ≥ 30 days after catheter insertion markedly improved the probability of TESI. Carriage of methicillin-resistant SAu since the start of PD was associated with a high incidence of TESI by these bacteria. On the contrary, resistance to mupirocin did not predict such a risk, probably due to the use of an alternative regime in affected patients. ♦
  
  
  CONCLUSIONS
  Adherence to current recommendations results in a low incidence of TESI in PD patients. Interventions on specific risk subsets have a potential to bring incidence close to negligible levels. Despite systematic screening and management, SAu carriage is still a predictor of TESI. Antibiotic susceptibility patterns may help to refine stratification of the risk of TESI by these bacteria. Early insertion of the peritoneal catheter should be considered whenever possible, to reduce the risk of later TESI.
authors.affiliation: Division of Nephrology, Vilanova da Gaia/Espinho Hospital Center, Portugal.
authors.forename: Clara
authors.initials: C
authors.lastname: Santos
authors.affiliation: Health Sciences Faculty, University of A Coruña, Spain Division of Nephrology, University Hospital of A Coruña, Spain Miguel.Perez.Fontan@sergas.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Fontán
authors.affiliation: Division of Nephrology, University Hospital of A Coruña, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Carmona
authors.affiliation: Division of Nephrology, University Hospital of A Coruña, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Calvo-Rodríguez
authors.affiliation: Division of Nephrology, University Hospital of A Coruña, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: López-Muñiz
authors.affiliation: Division of Epidemiology, University Hospital of A Coruña, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López-Calviño
authors.affiliation: Division of Nephrology, University Hospital of A Coruña, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Falcón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D055815:Young Adult
keywords: Peritoneal catheter; Staphylococcus aureus; mupirocin; peritoneal dialysis; tunnel and exit-site infection