The Type and Outcome of Exit-Site Infection in CAPD Patients

Baek, Mi Young; Kim, Yong Lim; Cho, Young Jun; Park, Son Hee; Kim, Jun Chul; Lee, Dong Wook; Cho, Dong Kyu

Abstract

Exit-site infection(ESI) is a troublesome catheter related complication of CAPD that may lead to peritonitis and require catheter removal, ESI is variably defined and classified. The rate of ESI and the outcome of treatment are also variably reported in literature. We conducted a retrospective study of 58 episodes of ESI(40 patients) between August 1997 and February 1999, and evaluated the episodes and types of ESI, organism isolated from ESI and their sensitivity, outcome of ESI, number and reason for catheter loss, and the current modality. The mean age was 48.9+/-11.5 years(31-70) and the male to female ratio was 22:18. The mean duration of CAPD before ESI was 34.1+/-29.6 months (1.5-114.2), and diabetic nephropathy was the cause of ESRD in 17.5% of cases. The types of catheter were two-cuff, coiled Tenckhoff in 17 patients, two-cuff, coiled swan-neck in 10 patients, two-cuff, straight swan-neck in 10 patients, and two-cuff, straight Tenckhoff in 3 patients. According to Twardowski's classification, acute infection in 33 patients and chronic infection in 25 patients were noted. Causative organisms of ESI were S. aureus, S. epidermidis, Pseudomonas, and E. cali in diminishing order of frequency. S. aureus was the most common organism in acute infection, and S. epidermidis was the most common organism in chronie infection. The mean duration of CAPD before ESI was 27.6+/-27.2 months in acute infection, and 42.8+/-30.8 in chronic infection (p<0.05). The duration of antibiotic treatment was 19.9+/-14.4 days in acute infection, and 42.7+/-27.2 days in chronic infection(p<0.05). In acute infection, peritonitis developed in 2 patients and 1 catheter was removed. In chronic infection, peritonitis developed in 1 patient and the catheter was removed. Three patients had the external cuff shaved due to persistent ESI which was unresponsive to antibiotics and local care. By the end of the study, 36 patients(90%) were still on CAPD, 2 patients(5%) had transferred to hemodialysis, and 2 patients(5%) had died. The cause of death was peritonitis in 1 patient, and cachexia in the other patient. In conclusion, exit-site infection responded relatively well to conservative treatment. However, exit-site infection is one of the major causes of catheter failure in CAPD. Therefore, careful exit-site care and examinations are needed.