Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey
Authors: Kopriva–Altfahrt Gertrude , König Paul , Mündle Michael , Prischl Friedrich , Roob Johannes M. , Wiesholzer Martin , Vychytil Andreas ,   The Austrian Study Group for Prevention of Peritoneal Catheter-Associated Infections, Arneitz Klaus , Karner Andrea , Artes Rene , Wolf Erich , Auinger Martin , Pawlak Andrzej , Hietzing Krankenhaus , Fraberger Johannes , Hofbauer Sabine , Waldviertel Landesklinikum , Galvan Georg , Salmhofer Hermann , Pichler Birgit , Wazel Melanie , Landeskliniken Salzburger , Gruber Manfred , Thonhofer Anni , Hager Alfred , Malajner Sabine , Heiss Susanne , Braunsteiner Thomas , Zweifler Monika , König Paul , Rudnicki Michael , Nephrologie Klinische Abteilung für , Kogler Richard , Kohlhauser Dietmar , Wiesinger Tatjana , Kopriva–Altfahrt Gertrude , Moser Elisabeth , Kotanko Peter , Loibner Herbert , Nitz Helga , Miska Hans Joachim , Wenzel René , Wölfler Monika , Mündle Michael , Breuss Heimo , Hölzl Bertram , Oberortner Wolfgang , Prischl Friedrich , der Kreuzschwestern Klinikum , Schmekal Bernhard , Riener Eva-Maria , Krankenhaus Allgemeines , Roob Johannes M. , Wonisch Waltraud , Vikydal Rudolf , Vychytil Andreas , Frank Barbara , Wieser Clemens , Wiesholzer Martin , Pokorny Karin 
Published: February 2020

Background

Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections.

Methods

In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria.

Results

Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol.

Conclusion

Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).