Peritoneal dialysis catheter-related infections

[Perit Dial Int 2017;37:141–54]

• exit site - presence of purulent discharge, with or without erythema of the skin at the catheter-epidermal interface
• tunnel - presence of clinical inflammation or ultrasound evidence of collection along the catheter tunnel

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Prevention of catheter infections

- Increased risk for S. aureus infections if:

• S. aureus nasal carrier

• diabetic

• immunocompromised.

- Daily application of topical mupirocin cream or ointment at the catheter exit site is recommended to decrease S. aureus exit site infections. Gentamicin cream can be used as an alternative to mupirocin. Triple antibiotic ointment (polymyxin, bacitracin, neomycin) is not superior to topical mupirocin.

- Consider ultrasound to assess for tunnel infection.

- If concomitant peritonitis, see PD-related Peritonitis

- C&S recommended. Tailor antibiotics to results.

- Oral antibiotics as effective as intraperitoneal antibiotics for catheter infections.

- Catheter removal recommended if:

• refractory (unresponsive to adequate course (≥ 3 weeks) of appropriate antibiotics) exit site and/or tunnel infection without peritonitis

• exit site and/or tunnel infection and concomitant or subsequent peritonitis.

- Tailor antibiotics to C&S results. Evaluate response at 1 week. If not improving and Staph infection, consider adding rifampin (450mg PO daily if weight < 50kg, 600mg PO daily if weight ≥ 50kg). If not improving and Pseudomonas infection, consider adding a 2^nd antipseudomonal drug, e.g. IP ceftazidime or tobramycin.

S. aureus/MRSA
Coagulase negative Staph
P. aeruginosa