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Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics
BACKGROUND: Although, Pseudomonas exit-site infection (ESI) is recognized as a major complication of peritoneal dialysis (PD) with high risk of catheter loss due to refractory/recurrent infection or peritonitis, there is remarkably little literature about treatment outcomes. International Society fo...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655795/ https://www.ncbi.nlm.nih.gov/pubmed/26613039 http://dx.doi.org/10.1093/ckj/sfv089 |
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author | Burkhalter, Felix Clemenger, Michelle Haddoub, San San McGrory, Jacqueline Hisole, Nora Brown, Edwina |
author_facet | Burkhalter, Felix Clemenger, Michelle Haddoub, San San McGrory, Jacqueline Hisole, Nora Brown, Edwina |
author_sort | Burkhalter, Felix |
collection | PubMed |
description | BACKGROUND: Although, Pseudomonas exit-site infection (ESI) is recognized as a major complication of peritoneal dialysis (PD) with high risk of catheter loss due to refractory/recurrent infection or peritonitis, there is remarkably little literature about treatment outcomes. International Society for Peritoneal Dialysis guidelines advise the use of one to two antibiotics; in addition, we change standard exit-site care by stopping prophylactic mupirocin and starting regular use of gentamicin 1% cream. METHODS: Retrospective review of outcomes of Pseudomonas ESI from January 2012 to March 2015. RESULTS: During the study period, a total of 135 patients were on PD with an overall incidence of any ESI of 0.36/patient-year. There were 14 patients with ESI episodes with Pseudomonas with a rate of 0.12/patient-year. In total, 13 of 14 patients with ESI episodes were treated with oral ciprofloxacin and/or intraperitoneal (IP) gentamicin or ceftazidime, plus topical gentamicin, with a success rate of 38% (5/13). One patient had gentamicin-resistant Pseudomonas species and was treated successfully with topical polymyxin/bacitracin cream. Median follow-up time in cured patients was 385 days (range 74–1107). Six patients had associated with Pseudomonas peritonitis, four during follow-up and two at initial presentation. Three patients had recurrent ESI with Pseudomonas, with one successfully re-treated with topical and IP gentamicin. In total, in only 50% of the patients was Pseudomonas ESI successfully treated. Five of the patients (36%) changed modality to permanent haemodialysis following catheter removal. CONCLUSION: Eradication of Pseudomonas ESI remains difficult even with the addition of topical gentamicin to the exit site. There should be a low threshold for catheter replacement. |
format | Online Article Text |
id | pubmed-4655795 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-46557952015-11-26 Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics Burkhalter, Felix Clemenger, Michelle Haddoub, San San McGrory, Jacqueline Hisole, Nora Brown, Edwina Clin Kidney J Contents BACKGROUND: Although, Pseudomonas exit-site infection (ESI) is recognized as a major complication of peritoneal dialysis (PD) with high risk of catheter loss due to refractory/recurrent infection or peritonitis, there is remarkably little literature about treatment outcomes. International Society for Peritoneal Dialysis guidelines advise the use of one to two antibiotics; in addition, we change standard exit-site care by stopping prophylactic mupirocin and starting regular use of gentamicin 1% cream. METHODS: Retrospective review of outcomes of Pseudomonas ESI from January 2012 to March 2015. RESULTS: During the study period, a total of 135 patients were on PD with an overall incidence of any ESI of 0.36/patient-year. There were 14 patients with ESI episodes with Pseudomonas with a rate of 0.12/patient-year. In total, 13 of 14 patients with ESI episodes were treated with oral ciprofloxacin and/or intraperitoneal (IP) gentamicin or ceftazidime, plus topical gentamicin, with a success rate of 38% (5/13). One patient had gentamicin-resistant Pseudomonas species and was treated successfully with topical polymyxin/bacitracin cream. Median follow-up time in cured patients was 385 days (range 74–1107). Six patients had associated with Pseudomonas peritonitis, four during follow-up and two at initial presentation. Three patients had recurrent ESI with Pseudomonas, with one successfully re-treated with topical and IP gentamicin. In total, in only 50% of the patients was Pseudomonas ESI successfully treated. Five of the patients (36%) changed modality to permanent haemodialysis following catheter removal. CONCLUSION: Eradication of Pseudomonas ESI remains difficult even with the addition of topical gentamicin to the exit site. There should be a low threshold for catheter replacement. Oxford University Press 2015-12 2015-09-12 /pmc/articles/PMC4655795/ /pubmed/26613039 http://dx.doi.org/10.1093/ckj/sfv089 Text en © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Contents Burkhalter, Felix Clemenger, Michelle Haddoub, San San McGrory, Jacqueline Hisole, Nora Brown, Edwina Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title | Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title_full | Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title_fullStr | Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title_full_unstemmed | Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title_short | Pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
title_sort | pseudomonas exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics |
topic | Contents |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655795/ https://www.ncbi.nlm.nih.gov/pubmed/26613039 http://dx.doi.org/10.1093/ckj/sfv089 |
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