Prevention of Exit-Site Infection and Peritonitis

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
November 2003

- Disconnect systems of CAPD result in lower rates of peritonitis; standard systems should not be used (Level I)
- Twin bag systems lower peritonitis rate and are preferred (Level I)
- The use of antibiotics with catheter replacement is superior to antibiotics with urokinase (Level II)

- There is no type of catheter or technique of insertion superior to prevent peritonitis(Level I-II)



- Antibiotic prohylaxis with first generation cephalosporin at insertion; routine use of vancomycin is not recommended (Level II)

- Therapy with mupirocin ointment is recommended especially for Staph. Aureus carriage intranasally (Level II)

Dialysis. Evidence for Peritonitis Treatment and Prophylaxis
1. PD systems and solution



5. Indications for the use of urokinase

6. Type of peritoneal dialysis catheter

7. Technique of insertion of peritoneal dialysis catheter

8. Prophylactic antibiotics for insertion of peritoneal dialysis catheter

12. Prophylaxis for exit site/tunnel infections using mupirocin

For rationale, each time read below the guidelines.

CSN-Canada

EBPG-Europe
2005 update

Confer to the ISPD-guidelines endorsed by EBPG
- No particular catheter is better than the standard (Evidence)
- Prophylactic antibiotics administered at insertion decrease infection risk (Evidence)
- Antibiotic protocols against S. aureus are effective in reducing the risk of S. aureus catheter infections (Evidence)
- Fungal prophylaxis during antibiotic therapy in programs that have high rates of fungal peritonitis
- When colonisation of exit-site, intensify exit-site cleaning

ISPD Guidelines/recommendations





For summary, see table 2, p 109: Antibiotic protocol options for preventing exit-site infections

KDOQI-US

UK-Renal Association

Module 3B: Peritoneal Dialysis
2007

 - PD units should undertake regular audit of their peritonitis and exit-site infection rates, including causative organism, treatment and outcomes. They should enter into active dialogue with their microbiology department and infection control team to develop optimal local treatment and prevention protocols
 - Flush-before-fill dialysis delivery systems should be used
 - Patients should undergo regular revision of their technique and receive intensified training if this is below standard
 - Initial catheter insertion should be accompanied by antibiotic prophylaxis
 - Invasive procedures should be accompanied by antibiotic prophylaxis and emptying the abdomen of dialysis fluid for a period commensurate with the procedure
 - Topical antibiotic administration should be used to reduce the frequency of Staph. aureus and Gram negative exit-site infection and peritonitis

Infectious Complications: Prevention Strategies