The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients

Park, Jun Beom; Kim, Jung Mi; Choe, Jun Heuk; Jo, Kyou Hyang; Jung, Hang Jae; Kim, Yeung Jin; Do, Jun Yeung; Yoon, Kyung Woo

Abstract

BACKGROUND: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MTEHODS: We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998.
RESULTS
The total follow-up was 2401 patient months (pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus (MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with reinsertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration : 14.0 months) The rates of ESI were more reduced after using mupirocin than before (l per 12.7 vs 34.0 pt.mon, p<0.01).
CONCLUSION
In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.