What are the treatment antibiotics for peritoneal dialysis catheter exit site infection?

From the Guidelines

Peritoneal dialysis catheter exit site infections should be treated with intraperitoneal antibiotics, with vancomycin plus empirical gram-negative rod coverage based on local antibiogram data, as the first line of treatment. The treatment regimen should include vancomycin 20-mg/kg loading dose infused during the last hour of the dialysis session, and then 500 mg during the last 30 min of each subsequent dialysis session, along with gentamicin (or tobramycin) 1 mg/kg, not to exceed 100 mg after each dialysis session 1. This approach is supported by the clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection, which recommend empirical dosing pending culture results 1.

Key Considerations

• The choice of antibiotic should be based on local antibiogram data to ensure effective coverage of potential pathogens.
• The treatment regimen should be adjusted based on culture results when available.
• Daily exit site care with chlorhexidine or povidone-iodine cleaning and application of mupirocin or gentamicin cream to the exit site is essential to prevent further infection.
• Patients should monitor for worsening signs of infection, including increased redness, swelling, pain, or purulent discharge, which may indicate tunnel infection requiring more aggressive therapy.

Treatment Adjustments

• If the infection fails to respond to therapy, the catheter should be removed and replaced using a different tunnel and exit site 1.
• In cases of catheter-related bacteremia, the catheter should be removed if the patient remains symptomatic for more than 36 hours or if the patient is clinically unstable 1.
• Preliminary reports suggest that catheter salvage may be possible in stable asymptomatic patients without exit site or catheter tunnel tract involvement, using a combination of systemic antibiotic therapy and catheter guidewire exchange 1.

From the Research

Peritoneal Dialysis Catheter Exit Infection Treatment Antibiotics

• The treatment of peritoneal dialysis catheter exit-site infections often involves the use of antibiotics, with the specific choice depending on the causative organism and local antibiotic sensitivity profiles 2, 3.
• Empiric therapy for exit-site infections may include the use of cefazolin or vancomycin, with or without additional coverage for gram-negative organisms 3.
• Targeted therapy may involve the use of antibiotics such as gentamicin, which has been shown to be effective in preventing exit-site infections, including those caused by gram-negative organisms 2.
• The use of mupirocin, either intranasally or at the exit site, has been shown to reduce the risk of Staphylococcus aureus exit-site and tunnel infections 3, 4, 5.
• However, the emergence of mupirocin-resistant S. aureus has brought this prophylactic strategy into question, and annual surveillance for resistant organisms is recommended 4.
• In cases where exit-site infections do not respond to treatment, catheter removal and replacement may be necessary 2, 4.

Prevention of Exit-Site Infections

• Meticulous exit-site care is vital in preventing exit-site infections, and daily cleaning of the exit site with a dedicated antimicrobial soap is essential for the longevity of the peritoneal dialysis catheter 6.
• The use of antibiotic creams and disinfectant agents, such as povidone-iodine, chlorhexidine, and electrolytic chloroxidizing solutions, can help to keep resident micro-organisms inhibited and reduce the risk of exit-site infections 6.
• Prophylaxis against S. aureus, using intranasal mupirocin or exit site mupirocin, can also help to reduce the risk of exit-site infections and peritonitis 5.