Tunnel and peritoneal catheter exit site infections in continuous peritoneal dialysis
- John M Burkart, MD
John M Burkart, MD
- Section Editor — Dialysis
- Professor of Medicine/Nephrology
- Wake Forest University Medical Center
- Anthony Bleyer, MD, MS
Anthony Bleyer, MD, MS
- Professor of Internal Medicine/Nephrology
- Wake Forest University School of Medicine
- Section Editor
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
Peritoneal dialysis is carried out by moving dialysis fluids into and out of the peritoneal cavity via a catheter made of a biocompatible material that is placed in a fistulous tract connecting the sterile peritoneum with the external, nonsterile environment. It is therefore not surprising that the tract, the exit site, and the peritoneum are prone to bacterial infection from a variety of causes such as catheter colonization, possible contamination at the time of spiking the dialysis fluid bag, or an exit-site or catheter tunnel infection.
There are seven important issues to consider with peritoneal dialysis catheter (tunnel and exit site) related infections:
●Evaluation of the exit site and diagnosis of infection
●Initial antibiotic therapy
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- PREVENTION OF CATHETER INFECTIONS
- Exit-site care
- - Acute care
- - Chronic care
- Antimicrobial prophylaxis
- - Gentamicin cream
- - Mupirocin
- Other prophylactic agents and approaches
- Miscellaneous considerations
- EVALUATION OF THE EXIT SITE AND DIAGNOSIS OF INFECTION
- Grading systems
- INITIAL ANTIBIOTIC THERAPY
- Mild infection
- Moderate infection
- Fungal infections
- RESISTANT INFECTION
- ANTI-FUNGAL PROPHYLAXIS
- INDICATIONS FOR CATHETER REMOVAL
- SITE AND TIMING OF NEW CATHETER PLACEMENT
- PREVENTION/TREATMENT OF RECURRENT INFECTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS