Diagnosis and management of exit site infection in peritoneal dialysis patients

Abstract

Exit site infection (ESI) is an important clinical problem in peritoneal dialysis (PD) patients and is a significant cause of peritonitis and catheter loss. While most ESIs are caused by skin commensals, rising incidence of atypical and resilient organisms such as mycobacteria, Pseudomonas and Burkholderia species has been observed. The diagnosis and management of these emerging pathogen remain difficult and poorly defined. This chapter highlights the evaluation and management of ESI in PD patients. The clinical features, microbiology, and ultrasonographic findings are discussed. The general and specific management of ESI due to different organisms will also be elaborated. ESI is usually a clinical diagnosis, but the use of bedside ultrasound can help assess for any collection around the cuff and tunnel tract involvement. Topical prophylaxis remains an effective way to prevent ESI. While the majority ESIs are related to skin flora and can be managed successfully by topical or systemic antimicrobials, clinicians should be alert to the emergence of resistant and atypical microorganisms. Surgical treatment should be reserved for ESI refractory to medical treatment or those with associated peritonitis.