Repeat Peritoneal Dialysis Exit-Site Infection: Definition and Outcomes

<jats:sec><jats:title>Background</jats:title><jats:p>The most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Retrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus ( n = 16, 52%) and Pseudomonas aeruginosa ( n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.</jats:p></jats:sec>