Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients

Document Type : Original Article


1 Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Kidney Diseases Research Center, Peritoneal Dialysis Ward, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran


Bachground: Peritonitis and exit site (ES) infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing. Materials and Methods: This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection. Results: A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02). Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months). In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months), and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months) (P = 0.03). Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025) and in dressing group (52% vs. 15%, P = 0.003). In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01). Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 − 84.4; P = 0.045), and 4.4 in men (95% CI = 1.26 − 15.19; P = 0.02). Conclusion: In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.


Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, et al. Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol 2005;16:539-45.  Back to cited text no. 1
Bayston R, Andrews M, Rigg K, Shelton A. Recurrent infection and catheter loss in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 1999;19:550-5.  Back to cited text no. 2
Piraino B, Bernardini J, Sorkin M. Catheter infections as a factor in the transfer of continuous ambulatory peritoneal dialysis patients to hemodialysis. Am J Kidney Dis 1989;13:365-9.  Back to cited text no. 3
Johnson DW, Dent H, Hawley CM, McDonald SP, Rosman JB, Brown FG, et al. Associations of dialysis modality and infectious mortality in incident dialysis patients in Australia and New Zealand. Am J Kidney Dis 2009;53:290-7.  Back to cited text no. 4
Borg D, Shetty A, Williams D, Faber MD. Fivefold reduction in peritonitis using a multifaceted continuous quality initiative program. Adv Perit Dial 2003;19:202-5.  Back to cited text no. 5
Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010;30:393-423.  Back to cited text no. 6
Fried LF, Bernardini J, Johnston JR, Piraino B. Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 1996;7:2176-82.  Back to cited text no. 7
Piraino B. Can we reduce rates of Staphylococcus aureus and other peritonitis in peritoneal dialysis patients? Perit Dial Int 2010;30:277-9.  Back to cited text no. 8
Chua AN, Goldstein SL, Bell D, Brewer ED. Topical mupirocin/sodium hypochlorite reduces peritonitis and exit-site infection rates in children. Clin J Am Soc Nephrol 2009;4:1939-43.  Back to cited text no. 9
Pommer W, Brauner M, Westphale HJ, Brunkhorst R, Krämer R, Bundschu D, et al. Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: Silver ring prophylaxis at the catheter exit study. Am J Kidney Dis 1998;32:752-60.  Back to cited text no. 10
Montenegro J, Saracho R, Aguirre R, Martínez I, Iribar I, Ocharán J. Exit-site care with ciprofloxacin otologic solution prevents polyurethane catheter infection in peritoneal dialysis patients. Perit Dial Int 2000;20:209-14.  Back to cited text no. 11
Crabtree JH, Burchette RJ, Siddiqi RA, Huen IT, Hadnott LL, Fishman A. The efficacy of silver-ion implanted catheters in reducing peritoneal dialysis-related infections. Perit Dial Int 2003;23:368-74.  Back to cited text no. 12
Danguilan RA, Evangelista LP, Abrenica MS, Rondilla SM. Comparative study of mupirocin and sodium fucidate in the prophylaxis of exit-site infections in CAPD patients. Perit Dial Int 2003;23:593-5.  Back to cited text no. 13
Kopriva-Altfahrt G, König P, Mündle M, Prischl F, Roob JM, Wiesholzer M, et al. Exit-site care in Austrian peritoneal dialysis centers-A nationwide survey. Perit Dial Int 2009;29:330-9.  Back to cited text no. 14
Tse KC, Lui SL, Cheng VC, Yip TP, Lo WK. A cluster of rapidly growing mycobacterial peritoneal dialysis catheter exit-site infections. Am J Kidney Dis 2007;50:e1-5.  Back to cited text no. 15
Schiffl H, Mucke C, Lang SM. Exit-site infections by non-diphtheria corynebacteria in CAPD. Perit Dial Int 2003;23:593-5.  Back to cited text no. 16
Conly JM, Vas S. Increasing mupirocin resistance of Staphylococcus aureus in CAPD – Should it continue to be used as prophylaxis? Perit Dial Int 2002;22:649-52.  Back to cited text no. 17
Pérez-Fontán M, Rosales M, Rodríguez-Carmona A, Falcón TG, Valdés F. Mupirocin resistance after long-term use for Staphylococcus aureus colonization in patients undergoing chronic peritoneal dialysis. Am J Kidney Dis 2002;39:337-41.  Back to cited text no. 18
Kim DK, Yoo TH, Ryu DR, Xu ZG, Kim HJ, Choi KH, et al. Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: A single center's experience over one decade. Perit Dial Int 2004;24:424-32.  Back to cited text no. 19
Tong MK, Leung KT, Siu YP, Lee KF, Lee HK, Yung CY, et al. Use of intraperitoneal urokinase for resistant bacterial peritonitis in continuous ambulatory peritoneal dialysis. J Nephrol 2005;18:204-8.  Back to cited text no. 20
Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. Perit Dial Int 1996;16 Suppl 3:S32-50.  Back to cited text no. 21
Cavdar C, Atay T, Zeybel M, Celik A, Ozder A, Yildiz S, et al. Emergence of resistance in staphylococci after long-term mupirocin application in patients on continuous ambulatory peritoneal dialysis. Adv Perit Dial 2004;20:67-70.  Back to cited text no. 22
Lima RC, Barreira A, Cardoso FL, Lima MH, Leite M Jr. Ciprofloxacin and cefazolin as a combination for empirical initial therapy of peritoneal dialysis-related peritonitis: Five-year follow-up. Perit Dial Int 2007;27:56-60.  Back to cited text no. 23
Moreira PR, Ferreira S, Almas AC, Peralva LE, Brega AP. Topic mupirocin ointment application at the CAPD catheter exit site reduces infection. J Bras Nefrol 2002;24:1-6.  Back to cited text no. 24
Takei NL. Evaluation of Staphylococcus aureus colonization after chronic use of mupirocin in patients undergoing continuous ambulatory peritoneal dialysis, Federal University of São Paulo, Brazil; 2003.  Back to cited text no. 25
Barretti P, Bastos KA, Dominguez J, Caramori JC. Peritonitis in Latin America. Perit Dial Int 2007;27:332-9.  Back to cited text no. 26
Piraino B, Bernardini J, Bender FH. An analysis of methods to prevent peritoneal dialysis catheter infections. Perit Dial Int 2008;28:437-43.  Back to cited text no. 27
Zimmerman SW, Ahrens E, Johnson CA, Craig W, Leggett J, O'Brien M, et al. Randomized controlled trial of prophylactic rifampin for peritoneal dialysis-related infections. Am J Kidney Dis 1991;18:225-31.  Back to cited text no. 28
Falagas ME, Fragoulis KN, Bliziotis IA. Oral rifampin for prevention of SAureus carriage-related infections in patients with renal failure – A meta-analysis of randomized controlled trials. Nephrol Dial Transplant 2006;21:2536-42.  Back to cited text no. 29
Fernandes N, Bastos MG, Cassi HV, Machado NL, Ribeiro JA, Martins G, et al. The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD): Characterization of the cohort. Kidney Int Suppl. 2008 Apr;(108):S145-51.  Back to cited text no. 30
Moraes TP, Pecoits-Filho R, Ribeiro SC, Rigo M, Silva MM, Teixeira PS, et al. Peritoneal dialysis in Brazil: Twenty-five years of experience in a single center. Perit Dial Int 2009;29:492-8.  Back to cited text no. 31
Lobo JV, Villar KR, de Andrade Júnior MP, Bastos Kde A. Predictor factors of peritoneal dialysis-related peritonitis. J Bras Nefrol 2010;32:156-64.  Back to cited text no. 32
Caramori, JCT. Peritonites em pacientes tratados com diálise peritoneal ambulatorial contínua: Estudo clínico e microbiológico [tese de doutorado]. São Paulo: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, 1999. [In portuguese]  Back to cited text no. 33
Kavanagh D, Prescott GJ, Mactier RA. Peritoneal dialysis-associated peritonitis in Scotland (1999-2002). Nephrol Dial Transplant 2004;19:2584-91.  Back to cited text no. 34
Alves FR, Dantas RC, Lugon JR. Higher incidence of catheter-related infections in a tropical climate. Adv Perit Dial 1993;9:244-7.  Back to cited text no. 35
Stinghen AE, Barretti P, Pecoits-Filho R. Factors contributing to the differences in peritonitis rates between centers and regions. Perit Dial Int 2007;27 Suppl 2:S281-5.  Back to cited text no. 36
Twardowski ZJ, Prowant BF. Current approach to exit-site infections in patients on peritoneal dialysis. Nephrol Dial Transplant 1997;12:1284-95.  Back to cited text no. 37
Naylor M, Roe B. A study of the efficacy of dressings in preventing infections of continuous ambulatory peritoneal dialysis catheter exit sites. J Clin Nurs 1997;6:17-24.  Back to cited text no. 38
Starzomski RC. Three techniques for peritoneal catheter exit site dressings. ANNA J 1984;11:9-16.  Back to cited text no. 39
Tanaka S, Yosizawa K, Sakuma M. Keeping the catheter exit site clean by sealing with a dressing film in patients under continuous ambulatory peritoneal dialysis. Adv Perit Dial 2002;18:158-60.  Back to cited text no. 40
Khanna R, Oreopoulos DG. Clinical management of patients on continuous ambulatory peritoneal dialysis. Perit Dial Bull 1983;3:54-7.  Back to cited text no. 41
Gokal R, Alexander S, Ash S, Chen TW, Danielson A, Holmes C, et al. Peritoneal catheters and exit-site practices toward optimum peritoneal access: 1998 update. (Official report from the International Society for Peritoneal Dialysis) Perit Dial Int 1998;18:11-33.  Back to cited text no. 42
Prowant BF, Warady BA, Nolph KD. Peritoneal dialysis catheter exit-site care: Results of an international survey. Perit Dial Int 1993;13:149-54.  Back to cited text no. 43
Watson AR, Vigneux BE, Hardy BE, Balfe JW. Six-year experience with CAPD catheters in children. Perit Dial Bull 1985;5:119-22.  Back to cited text no. 44
Chronic PD catheter exit site care. Shower technique (for the Healthy Exit Site). Available from: [Last accessed on 2014 Apr 01].  Back to cited text no. 45