Journal
JOURNAL OF NEPHROLOGY
Volume 34, Issue 2, Pages 493-501Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s40620-020-00788-z
Keywords
Peritoneal dialysis (PD); Exit-site infection (ESI); Tunnel infection; Peritonitis; Catheter insertion; PD complications; End-stage renal disease (ESRD)
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In a study analyzing infective episodes in 123 CAPD patients, positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site significantly reduced cuff colonization by bacteria, leading to decreased exit site infections, tunnel infections, and peritonitis.
Background Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4 cm instead of 2 cm internal to the exit-site. Methods We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 +/- 16.8) treated for 3337 months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. Results 31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12 months and 61.8% at 36 months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months. Conclusions Positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.
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