Exit site infections: systematic microbiologic and quality control are needed.

For the period January 2005 to June 2008, we reviewed the rates, causes, and outcomes of exit-site infection (ESI) among 137 consecutive patients [mean age: 51 +/- 16 years; 17 (12.4%) with diabetes; 76 (55%) on automated PD; time at risk: 240.41 dialysis years; mean follow-up: 20.4 +/- 13.8 months]. Treatment protocol included mini-laparotomy and Popovich-Moncrief placement method, with presurgical cefazolin prophylaxis and routine prescription of topical mupirocin for the exit site. Oral cotrimoxazole was the initial empirical ESI treatment. A total of 49 patients (36%) experienced 76 episodes of ESI, for a global incidence of 0.31 episodes per year at risk. Gram-positive organisms occurred in 56% of the cases, and gram-negative organisms in 27%. Staphylococcus aureus caused 15 ESIs (0.06 episodes/patient-year), and only 15% of gram-positive organisms were methicillin resistant. Methicillin-resistant S. aureus were all sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs (0.04 episodes/patient-year). Other Enterobacteriaceae occurred at a rate of 0.03 episodes/patient-year. Fungal ESLs occurred at a rate of 0.004 episodes/patient-year The ESI cure rate was 96%. In 3 patients, the catheter was removed, but only 2 patients (2.6%) experienced ESI-related peritonitis. Our unit's treatment policy and prophylactic use of exit-site mupirocin resulted in a low S. aureus ESI rate without an alarming incidence of gram-negative or Pseudomonas infections. Routine microbiologic and quality control is mandatory for strategies individualized to the dialysis center.