Water avoidance and modification of exit-site care with stoma bag results in reduced exit-site infection rate in peritoneal dialysis patients

Aim: Infection is one of the drawbacks associated with peritoneal dialysis (PD) and is related to significant morbidity. After we experienced an increase in exit-site infection (ESI) rate, mostly derived from environmental and water-derived organisms, we hypothesized that preventing exit-site exposure to water and narrowing local antibiotics range will reduce colonization and subsequent infection. Materials and methods: In this study, we aimed to estimate PD-related infections after exit-site policy change in a prospective study cohort of 27 participants compared to a control group of 58 participants. The modification of exit-site care consisted of applying a stoma bag during daily shower to prevent water exposure and conversion of local antibiotic from gentamycin to mupirocin. Primary outcome was catheter-related infection. Secondary outcomes were peritonitis rate and infection-related outcomes. Results: The study group had a significantly lower ESI and ESI from environmental organisms' free probability. Rate of ESI from all causes was 0.054 +/- 0.09 vs. 0.031 +/- 0.09 episodes per patients' month for the control and study group, respectively (p = 0.049). Rate of environmental organism-related ESI was 0.047 +/- 0.07 vs. 0.015 +/- 0.08 episodes per patients' months for control and study group, respectively (p = 0.042). A higher risk of ESI from all organisms, and specifically from environmental organisms, was associated with being in the control group and a longer follow-up period. Rate of peritonitis was similar in both groups. Conclusion: The adjusted exit-site care policy significantly lowered ESI incidence. Avoidance of water exposure may have contributed to lessen bacterial colonization.

Automated summary

This study aimed to evaluate infections in PD patients after changing exit-site policy, finding that the adjusted care significantly reduced ESI incidence, potentially by avoiding water exposure and lessening bacterial colonization.