PD Exit-Site Infections Raise Peritonitis Risk

Patients on peritoneal dialysis (PD) who experience an exit-site infection (ESI) are at increased risk for peritonitis, data from a Canadian study show.

The study, led by Manish M. Sood, MD, of the University of Manitoba in Winnipeg, included 962 patients who started PD from January 2000 to December 2009. During the study period, 1,002 ESI and 1,228 peritonitis episodes occurred. For the study, patients with ESI were matched to those without an ESI based on PD duration.

After adjusting for gender, diabetes, and Aboriginal status, patients who experienced an ESI caused by gram-positive bacteria had a significant 75% increased risk for peritonitis compared with patients who did not have an ESI, Dr. Sood's group reported online ahead of print in Nephrology Dialysis Transplantation. An ESI caused by coagulase-negative Staphylococcus or Staphylococcus aureus were associated with a significant 2.2-fold and 5.8-fold increased risk, respectively. Gram negative and culture negative infections were not associated with increased peritonitis risk. The researchers noted that the increased risk in peritonitis associated with an ESI was present despite appropriate treatment of the ESI with antibiotics.

“These results suggest that, following an ESI, patients remain at high risk for the development of peritonitis, and that further interventions, above and beyond treatment of ESI may be needed,” the authors wrote.

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