Exit site infection in continuous ambulatory peritoneal dialysis single center experience

Hong, Soo Hee; Kim, Jeong Eun; Kwak, Choong Hwan; Lee, Ki Tae; Hwang, Eun Ah; Han, Seung Yeup; Park, Sung Bae; Kim, Hyun Chul

Abstract

BACKGROUND: Catheter-related infection is one of the most important causes of technical failure in peritoneal dialysis patients. We have examined the incidence and etiology of exit-site infection (ESI) at Keimyung University Dongsan medical center.
METHODS
Between January 2001 and December 2003, 292 new patients received peritoneal dialysis using double cuffed straight Tenckhoff catheter and were reviewed retrospectively.
RESULTS
In 292 patients, 81 (27.7%) patients experienced ESI and a total of 97 episodes of ESI has occurred during study period. The overall incidence of peritonitis during peritoneal dialysis was 0.27 episodes/patient-year. According to Twardowski's classification, equivocal infection in 14.4%, acute infection in 68.1% and chronic infection in 17.5% were noted. Staphylococcus aureus was the most frequently isolated organism, followed by Staphylococcus epidermidis, and Pseudomonas aeruginosa. The duration of treatment was significantly longer in chronic infection group than acute infection group (44.6 days vs. 18.5 days, p<0.05). The rates of Pseudomonas infection (p<0.05) and catheter replacement (p<0.05) were significantly higher in the chronic infection group than in the acute infection group. There was one catheter loss due to refractory peritonitis and three deaths unassociated with ESI during mean follow-up of 20.3 months.
CONCLUSIONS
Exit-stie infection is still a major causes of peritonitis and catheter failure. Because of suboptimal quality of practice guideline, additional studies on the definition, prevention and treatment of ESI are required.