Peritoneal Catheter Infections Research Articles

Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors

Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors
 The French Language Peritoneal Dialysis Registry (RDPLF) record since 1997 all data dealing with peritoneal catheter insertion and follow up.
 The aim of this study is to analyze catheter infections on 10801 catheters in 144 centres from January 1, 1997 and December 31, 2018.
 Infections are more common in the first month and 50% occur before the tenth month. The risk of infection increases in case of wall hematoma, initial fluid leakage, and obesity. It decreases with the use of prophylactic antibiotics at the time of catheter insertion, with experienced operator, if the first dressing is delayed for 7 days, and with mupirocin as exit-site prophylaxis.
 During last two decades the percentage of Staphylococcus aureus infections has decreased, whereas the proportion of Pseudomonas, Corynebacterium and other Gram + cocci increased.
 The incidence of catheter infections is low compared to literature data: it decreased to 0.16 episodes per year for the 2013-2017 period.
 Adherence to ISPD guidelines: preoperative antibioprophylaxis is the most followed guideline (70.7% of catheter implantations in 2018). Local antibioprophylaxis concerns only 15.6% of catheters, and remains concentrated in a few centres ; mupirocin is the most frequently used agent. Screening for nasal carriage of S. aureus is performed in only 42% of cases.
 The catheter section of the RDPLF has allowed the follow-up of clinical practices incidence of infections and ecology for 21 years, both at the national and center level Our study confirms a wide variability in clinical practices, compared to ISPD guidelines.

The influence of hygienic practices to the exit site/tunnel on peritoneal catheter infections.

In Peritoneal Dialysis (PD), correct handling of the equipment and especially of the catheter exit site are essential. The PD nurse is responsible for preparing the patient to be able to carry out self care. As there are no universally accepted procedures for catheter care, we evaluated the procedure recommended in our unit, to identify the level of achievement by our patients and compare it with the infection incidences of exit site/tunnel (ES/T). 31 patients were surveyed on aspects related with hygiene, care and support of the catheter. This was complemented with a direct observation of the way of fixing and protecting the catheter and exit site, relating these facts with the incidence of infection. The results show the incidence of the infection is similar to data from other centres. It seems that the non compliance with the recommendations is due to either a misunderstanding on the patients' part or difficulty to adapt these recommendations to their particular way of life.

Catheter infections as a factor in the transfer of continuous ambulatory peritoneal dialysis patients to hemodialysis.

The effect of peritoneal catheter infections on the transfer of continuous ambulatory peritoneal dialysis (CAPD) patients to hemodialysis over a 9-year period were examined. Twenty-seven percent (68/247) of all patients were transferred permanently to hemodialysis after a mean of 15 +/- 14 months of CAPD. An additional 29% transferred temporarily one or more times during the study period (mean time of peritoneal dialysis, 35 +/- 23 months). The reasons for permanent transfer to hemodialysis were catheter infections (15/68, 22%), peritonitis (13/68, 19%), catheter infections associated with peritonitis (10/68, 15%), patient preference (9/68, 13%), mechanical problems (4/68, 6%), noncompliance (7/68, 10%), inadequate clearance or ultrafiltration (6/68, 9%), with other reasons for the remainder (4/68, 6%). Temporary transfers to hemodialysis were also mainly due to catheter infections (32%), peritonitis (23%), and simultaneous catheter infections and peritonitis (24%). Catheter infection rates were much higher in the groups that permanently and temporarily were transferred to hemodialysis in comparison with those patients who remained on peritoneal dialysis. We conclude that catheter infections are a leading cause of both temporary and permanent transfer of CAPD patients to hemodialysis.

Exit-Site Location Does Not Influence Peritoneal Catheter Infection Rate

Peritoneal catheter infections are a cause of peritonitis, catheter loss, and permanent transfer of continuous ambulatory peritoneal dialysis (CAPD) patients to hemodialysis. Risk factors for catheter infections have not been delineated. We investigated the location of the peritoneal exit-site location as a risk factor for catheter infection and loss. There was no relationship between catheter infection rates and exit location. Catheters exiting on the beltline had a median infection rate of 0.5 episodes/year, as opposed to 1.2 episodes/year for catheters exiting above the beltline and 0.9 episodes/year for catheters exiting below the beltline (ns). The percentage of catheters that became infected and required removal was the same for catheters exiting above, below, or on the beltline. Although we recommend avoiding the beltline for patient comfort, exit-site location is not an important determinant of infection rates or catheter outcome.