Background Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4 cm instead of 2 cm internal to the exit-site. Methods We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 ± 16.8) treated for 3337 months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. Results 31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12 months and 61.8% at 36 months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months. Conclusions Positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.

The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients / L. Nardelli, A. Scalamogna, P. Messa. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - (2020). [Epub ahead of print] [10.1007/s40620-020-00788-z]

The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients

L. Nardelli
Primo
;
P. Messa
Ultimo
2020

Abstract

Background Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4 cm instead of 2 cm internal to the exit-site. Methods We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 ± 16.8) treated for 3337 months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. Results 31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12 months and 61.8% at 36 months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months. Conclusions Positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.
Catheter insertion; End-stage renal disease (ESRD); Exit-site infection (ESI); PD complications; Peritoneal dialysis (PD); Peritonitis; Tunnel infection
Settore MED/14 - Nefrologia
2020
9-lug-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/752218
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