Peritoneal Dialysis Catheter ESIs

Q: 27 year old male on kidney transplant list and now on peritoneal dialysis is admitted for sepsis and hypotension after his weekend trip to the water park. The probable source of sepsis appears to be a peritoneal dialysis catheter exit site. Surgical service is consulted in addition to initiation of antibiotics and continuous renal replacement therapy (CRRT). All of the following are considered as preventive measures to decrease exit site infections (ESIs) except?

A) Daily topical antibiotic at the exit site
B) Daily topical nasal antibiotics
C) Cover the exit site with an ostomy bag while swimming
D) Discourage pets at house
E) Regular cleaning of the exit site with chlorhexidine solution



Answer: B

The objective of the above question is to emphasize that regular application of nasal antibiotics do not decrease the infection rate in patients with chronic catheter insertion.  Also, another objective of the above MCQ is to highlight the risk of zoonotic infections as a probable cause of sepsis in such patients (choice D).

#surgicalcriticalcare
#nephrology
#infectiousdiseases


References:

1. Szeto CC, Li PK, Johnson DW, et al. ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int 2017; 37:141.

2.  Broughton A, Verger C, Goffin E. Pets-related peritonitis in peritoneal dialysis: companion animals or trojan horses? Semin Dial 2010; 23:306.