Peritoneal
catheter exit-site and tunnel
infections remain critical problems in patients undergoing
peritoneal dialysis.
Catheter-related
peritonitis occurs in about 20% of patients and exit-site
infections are responsible for
catheter removal in more than one-fifth of the cases. For the last 2 years in the Department of Nephrology, San Bortolo Hospital, Vicenza, Italy, we have been treating exit-site
infections caused by Pseudomonas with
sodium hypochlorite packs as well as systemic and local
antibiotic therapy. Considering the encouraging results obtained on
Pseudomonas infection, we decided to utilize the same schedule for the treatment of exit-site
infections caused by other germs which are generally difficult to eradicate to prevent
peritonitis and
catheter removal. Between 2003 and 2004, 10 patients contracted
infection of the exit-site. All patients underwent a swab test because of the reddening and the purulent secretion of the exit-site. The swab resulted positive for Pseudomonas in 7 patients, Corynebacterium sp. in 2 patients, and Candida albicans in 1 patient. All patients were treated with systemic
antibiotic therapy or antifungal
therapy, local
sodium hypochlorite 50% packs. After 15 days all patients were submitted to a swab test of the exit site. In all patients, the swab test resulted negative after 15 days and 1 month, and they could continue
peritoneal dialysis. This procedure avoided peritoneal
catheter removal and temporary switch to
hemodialysis in all patients with exit site
infection. The mechanism of action is related to the wide antimicrobial spectrum and the rapid action of
sodium hypochlorite possibly creating a protective barrier on the exit-site.