Case Of Exit Site Infection Research Articles

#784 Peritoneal dialysis-related infections by Kocuria kristinae: cases from a Mexican hospital

Abstract Background and Aims Kocuria species, gram-positive actinobacteria, are typically found in the environment, on human skin and as oral flora. These microorganisms are considered saprophytes and non-pathogenic. They rarely cause infections. Patients generally have some compromise due to underlying conditions, including solid tumors, hematologic malignancies, or metabolic disorders. There are few cases in the literature of peritoneal dialysis-associated peritonitis due to these germs. Reports of exit site infections or tunnel infections are even rarer or doesn't exist. Method Retrospective description of 4 cases of exit site and/or tunnel infections due to Kocuria kristinae over a 3-year period in a single center. Results Four cases of exit site infection were evaluated, with an average age of 63.2 ± 8.8 years. Half of the patients were diabetic. No patient had a history of peritoneal dialysis-related infection. The dialysis modality for all patients was CAPD (Continuous Ambulatory Peritoneal Dialysis). All patients presented symptoms of exit site infection, such as erythema and purulent discharge, but none of them had peritonitis. Three cases were treated with quinolones, and one received linezolid. One case received two antibiotic treatment regimens without an adequate response, and tunnel infection developed, required the removal of the dialysis catheter and a change in modality to HD (hemodialysis). Conclusion Exit site infections due to Kocuria are extremely rare. Despite the absence of specific management guidelines, the response to treatment is usually adequate. Due to the theoretical ability to produce biofilm, Kocuria infections should be considered a potential risk for recurrence and refractory disease. To our knowledge, there are no reports of exit site infections due to Kocuria.

#5521 TENCKHOFF CATHETER EXIT-SITE INFECTION BY ACTINOMYCES ODONTOLYTICUS: A RARE CASE

Abstract Background and Aims Actinomyces odontolyticus is an anaerobic Gram-positive bacteria, which can be found among the commensal flora of the mouth and oropharynx. Diagnosis of infections due to this microorganism can be difficult because of its rarity, indolent course and lack of specific symptoms. Only one case of exit-site infection (ESI) due to Actinomyces odontolyticus in a patient on continuous ambulatory peritoneal dialysis (CAPD) has been reported. This work aims to report a case of ESI due to this rare agent. Method We present a case of Tenckhoff catheter ESI due to Actinomyces odontolyticus in a patient on CAPD. Results Case report: We report the case of a 26-year-old woman with a personal history of dyslipidemia, arterial hypertension and end-stage chronic kidney disease caused by Alport Syndrome in a CAPD program since April 2016. In June 2020, the patient presented an episode of refractory ESI due to methicillin-sensitive Staphylococcus aureus and was submitted to a shaving of the external cuff of the Tenckhoff catheter, with good subsequent evolution. The patient had no complications related to the catheter until April 2021, when she presented purulent drainage through the exit-site associated with erythema of the surrounding area. The consecutive exit-site swabs were negative. She underwent antibiotic therapy with cotrimoxazole for 2 weeks with apparent resolution. However, in May 2021, the patient presents again erythema and purulent drainage and, at that time, a rare agent was isolated in the swab: Actinomyces odontolyticus with resistance to penicillin, amoxicillin, ceftriaxone and cotrimoxazole. Given this isolation, the patient was treated with doxycycline 100mg every 12 hours for 4 weeks. The evolution was favorable with resolution of the infection and absence of recurrence for a 6-month follow-up. At the end of this follow-up time, the patient was transplanted. Conclusion Actinomyces odontolyticus is a bacteria of the commensal flora of the oral cavity and upper gastrointestinal tract, which can acquire pathogenicity in situations of impaired mucosal integrity and in immunosuppressed patients. Infections caused by this agent are rare and represent a diagnostic challenge due to its growth in an anaerobic environment and prolonged isolation time (5 days to 4 weeks). The immunosuppression conferred by chronic kidney disease and the history of external cuff shaving may have propitiated the infection by this rare opportunistic agent in our patient. The ESI presented for the patient in the previous month, which did not have an identified agent, was possibly caused by Actinomyces odontolyticus, but it was not isolated probably due to culture difficulties. The treatment of Actinomyces infections is generally conservative with 2 to 4 weeks of high-dose of intravenous penicillin, followed by 2 to 6 months of oral antibiotic therapy. In case of allergy, regimens with ceftriaxone, doxycycline, clindamycin or carbapenems are recommended. There is no consensus on the duration of treatment, with some authors recommending a minimum of 2 to 6 weeks. The mentioned patient was treated with 4 weeks of doxycycline according to the sensitivity test and the result was favorable, without the need to remove the catheter.

Two plus one port laparoscopic assisted continuous ambulatory peritoneal dialysis insertion modified technique: a case series.

A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure. This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure. The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.

Peritoneal dialysis-associated infection caused by Mycobacterium abscessus: a case report

BackgroundPeritoneal dialysis (PD)-associated infection caused by Mycobacterium spp. is rare. Mycobacterium abscessus is one of the most resistant acid-fast bacteria, and treatment is also the most difficult and refractory. Thus, we report a case of PD-associated peritonitis caused by Mycobacterium abscessus that was difficult to treat and led to PD failure.Case presentationWe recently encountered a 56-year-old man who developed PD-associated infection. We initially suspected exit-site infection (ESI) and tunnel infection (TI) caused by methicillin-resistant coagulase-negative Staphylococcus. However, antibiotic therapy did not provide any significant improvement. Thus, we performed simultaneous removal and reinsertion of a PD catheter at a new exit site. The patient subsequently developed peritonitis and Mycobacterium abscessus was detected in the peritoneal effluent. Thus, the reinserted catheter was removed, hemodialysis was started, and the patient was eventually discharged.ConclusionsIn cases of refractory ESI or TI, it is important to consider non-tuberculous mycobacteria as the potentially causative organism. Even if acid-fast bacterial staining is negative or not performed, detection of Gram-negative bacillus may lead to suspicion and early identification of Mycobacterium spp. In PD-associated infection by Mycobacterium abscessus, catheter removal is necessary in many cases. Simultaneous removal and reinsertion of the catheter is not recommended, even in cases of ESI or TI. Reinsertion should only be attempted after complete resolution of peritoneal symptoms. After removal of the catheter, careful follow-up is necessary, paying attention to complications such as wound infection, peritonitis, and ileus. In addition, the selection and treatment period of antibiotics in PD-associated infection by Mycobacterium abscessus remains unclear, and it is an important topic for future discussion.

An “Atypical” Case of Exit Site Infection in Peritoneal Dialysis

An “Atypical” Case of Exit Site Infection in Peritoneal Dialysis

Therapeutic Passes: Highlighting Caregivers' Attitudes and Beliefs Among the Pediatric Blood and Marrow Transplant Population

s / Biol Blood Marrow Transplant 21 (2015) S391eS397 S397 Findings & Interpretation: A total of 39 patients were evaluated from September 2013 to June 2014. Of these, 22 (56%) underwent allogeneic and 17 (44%), autologous HSCT. Twenty (51%) used double lumen catheters, which were inserted predominantly in the internal jugular vein (79%). CBSI was confirmed in 12 patients. In addition, there were three clinically overt infections, namely one case of tunnel infection and two cases of exit site infection. Of all catheterrelated infections, nine occurred in patients who underwent autologous transplantation. Gram-negative bacteriawere the main microorganisms, the most frequent being Klebsiella pneumonia, isolated in three cases. Discussion & Implications: CBSI occurred despite of the use of a dressing indicated to control local microbiota and prevent infections. Of note, the identified microorganisms were not natural of the skin reservoir. This finding, added to the infectious vulnerability of the studied population, instigates the development of experimental studies which aim to assess the efficacy and cost-benefit of CHXGID to reduce infection in patients submitted to HSCT. Moreover, prevention of infections cannot be solely associatedwith the use of a protective device, but with the adoption of a combination of recommended measures, such as hand hygiene before using a catheter.

Effectiveness of different types of care for the peritoneal dialysis catheter exit site: a systematic review

Background Prevention of infection is considered essential for satisfactory maintenance of peritoneal dialysis. Infections of the peritoneal dialysis catheter tunnel and exit site are considered to be serious infections that may predispose patients to peritonitis and its consequences. Objective To evaluate and summarise the best available evidence on the effectiveness of care for the peritoneal dialysis catheter exit site. Inclusion criteria Types of participants Adult and paediatric patients receiving peritoneal dialysis Types of Interventions Antiseptics, topical antimicrobials agents, dressings and educational interventions Type of studies Randomised controlled trials Types of Outcomes Incidence of tunnel and exit site infection and peritonitis, caused by Staphylococcus aureus, Pseudomona aeruginosa, Haemophilus, Neisseria, Escherichia coli, etc. Search strategy All studies, published (in MEDLINE, CINAHL and COCHRANE databases) and unpublished, in English, Spanish, Portuguese and French, carried out between 1996 and February 2009 were retrieved. ,. Methodological quality The methodological quality of included articles was assessed by two independent reviewers using critical appraisal tools from the Joanna Briggs Institute. Data extraction Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis Results were combined in meta-analysis where appropriate. Results Nine randomized controlled trials were included. In one study that compared the effectiveness of daily application of gentamicin cream with mupirocin, in the gentamicin group there were a total of 15 infections of the exit site compared to the mupirocin group where there were 29 infections (OR= 2.72; 95% CI 1.28-5.77); there were 22 incidences of peritonitis in the gentamicin group, compared to 28 incidences of peritonitis in the mupirocin group ( OR= 1.51; 95% CI 0.74-3.05). In three studies, patients received povidone-iodine and the control group received standard care. The overall results of the meta-analysis estimated an OR=0.83 with 95% CI 0.47–1.45 for the prevention of infection of the exit site and an OR=0.77 with 95% CI 0.44–1.36 for prevention of peritonitis. One study compared the effectiveness of chlorhexidine versus liquid soap, showing that there was a statistically significant lower exit-site infection rate in the group of patients that used chlorhexidine soap compared with the group that used pure liquid soap.(OR 0.35 with 95% CI 0.13-0.94). Another study compared povidone-iodine vs. chlorhexidine vs. sodium hypochlorite, and found no statistically differences between povidone and chlorhexidine and found no differences between the use of povidone and sodium hypochlorite. Another three studies compared mupirocina vs. standard care; mupirocina vs. fusidic acid; and fusidic acid vs. ofloxacin, and found no differences in reducing exit site infections or peritonitis. Conclusions Some interventions appear to be more effective than others in terms of peritoneal dialysis catheter exit site care. These advantages are related to a lower number of cases of exit site infection and, consequently, peritonitis. The application of an antiseptic to the peritoneal dialysis catheter exit site reduces infections and prevents the peritonitis that is a consequence of exit site infection; however, the results do not demonstrate the superiority of any one of povidone, chlorhexidine, hypochlorite or washing with soap.

Atypical Mycobacterial Exit-Site Infection and Peritonitis in Peritoneal Dialysis Patients on Prophylactic Exit-Site Gentamicin Cream

We report 9 cases of exit-site infection and continuous ambulatory peritoneal dialysis peritonitis associated with atypical mycobacteria. All patients had been using topical gentamicin cream as prophylaxis for exit-site infection before the onset of these infections. Gentamicin cream is postulated to be a potential risk factor for atypical mycobacterial infection because of selective pressure on other micro-organisms. The microbiology of atypical mycobacteria and the treatment for atypical mycobacterial infections are discussed.

The use of the PleurX catheter in the management of non-malignant pleural effusions

To evaluate the effectiveness of the PleurX catheter in the management of recurrent non-malignant pleural effusions. All subjects who underwent a PleurX catheter placement between 2003 and 2009 were evaluated. General demographic data, time to pleurodesis, complications, and a satisfaction questionnaire were collected. The subjects were divided into two groups. Group I included patients with non-malignant effusions and group II included patients with malignant effusions. A total of 64 subjects were included in the final data analysis. A total of 23 subjects were included in group I and 41 subjects were included in group II. The diagnoses in group I included congestive heart failure (CHF; 13), hepatic hydrothorax (8), traumatic bloody (1), and idiopathic exudative (1). The diagnoses in group II included lung cancer (20), breast cancer (11), colon cancer (5), prostate cancer (2), B-cell lymphoma (2), and mesothelioma (1). The time to pleurodesis was 36 ± 12 days for group II compared to 110.8 ± 41 days for group I (p < 0.0001). The mean satisfaction score was similar in both groups (3.8 ± 0.4). Time to pleurodesis was significantly shorter in hepatic hydrothorax compared to CHF (73.6 ± 9 days vs. 113 ± 36 days, p = 0.006). There was one case of exit site infection in a patient with hepatic hydrothorax. Among subjects who were alive at 3 months after the catheter removal, none had recurrence of their pleural effusion. The Denver catheter was effective in achieving pleurodesis in non-malignant pleural effusions. The complication rate was low and patient satisfaction was high.

Complications of indwelling venous access devices in patients with gynecologic malignancies☆

Objective The purpose of this study was to evaluate the complication rates associated with indwelling venous access devices in patients with gynecologic malignancies. Methods Following IRB approval, a computerized database identified women that had indwelling access devices placed for chemotherapy from March 1999 to June 2001. A retrospective chart review identified 116 venous access devices that were placed in 104 patients. All devices were silicone and had a closed tip design with a three-position valve. Data were collected on patient demographics, clinicopathologic features, type of venous device, and complications. The χ 2 test was used for statistical analysis. Results Of the 104 patients, 79 had ovarian cancer, 11 had uterine cancer, 10 had cervical cancer, 2 had fallopian tube cancer, and 2 had vaginal cancer. The median age was 61 years. There were a total of 116 venous devices placed: 65 external catheters (EC) and 51 subcutaneous ports (SP). Seventy-nine percent of the patients were administered low-dose coumadin (1 mg/day) for catheter clot prophylaxis. There were three operative complications in the EC group and two in the SP group ( P = NS). The most common postoperative complications were infection and thrombosis. Nineteen patients in the EC group experienced a catheter-related infection versus 5 in the SP group ( P = 0.025). In the EC group, there were 11 cases of site infection and 8 cases of line sepsis. In contrast, there were 3 cases of exit site infection and 2 cases of line sepsis in the SP group. Deep vein thrombosis occurred in 5 patients with EC and 3 patients with SP ( P = NS). Twenty-seven patients with EC had the device removed for catheter-related complications versus 2 patients with SP ( P = 0.001). Six patients inadvertently removed their EC. Conclusions There is a significantly higher postoperative complication rate in gynecologic oncology patients with external catheters versus subcutaneous ports. Infection and catheter-related malfunction are more common in patients with external catheters. We recommend the use of subcutaneous ports in the majority of patients with gynecologic malignancies.

Topical antifungal treatment cures exit-site fungal infection

Exit-site fungal infection, although rarely reported, may be a critical complication in patients on peritoneal dialysis. There is no optimal treatment of exit-site fungal infection. We report four cases of exit-site infection with Candida parapsilosis. Four-week treatment with topical sulconazole cream was administered. Fungal infection was cured in all patients but followed by exit-site bacterial infection in two patients. The topical application of sulconazole cream is recommended for exit-site fungal infection. © 2002 by the National Kidney Foundation, Inc.

Intermittent peritoneal dialysis (IPD) in the elderly

Twenty-one elderly patients with end-stage renal disease (ESRD) secondary to various etiologies received IPD at our unit. It was done manually by trained staff nurses. Each patient received 20-24 one hour exchanges of 2 liters PD solution twice a week through a permanent Tenckhoff catheter. Mean age of patients was 63 years (range 60–96),12 were male and 9 female. Mean duration of stay on IPD was 23 months (range 18–41). The etiologies of ESRD were: diabetes mellitus (9 patients), unknown etiology (7), hypertension (3), glomerulonephritis and liver cirrhosis (hepatitis C) (2). The peritonitis rate was one episode per 16.3 patient/month. The causative organisms were staphylococcus, coliforms, acinobacter and pseudomonas. Six patients died due to each of the following: 2 septicemia not related to PD; 2 hepatic failure; 2 massive myocardial infarction. Two patients were changed to hemodialysis due to recurrent peritonitis. We observed 7 episodes of catheter exit-site infection; causative organisms were staphylococcus (4), and pseudomonas (3). Staphylococcus cases of exit-site infection responded to local fucidin ointment and oral antibiotic, while in the pseudomonas cases the catheter had to be removed. All patients received erythropoietin and have maintained good hemoglobin levels (10.1 ± 1.2 gm%). They also had adequate control of their serum creatinine and urea level. As the patients improved, they became less dependent on their relatives.