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Division of Nephrology and Dialysis,1 Department of Medicine VI, Wilhelminenspital, Vienna; Nephrology and Hypertensiology,2 University Hospital of Medicine IV, Medical University of Innsbruck; Division of Nephrology and Dialysis,3 Department of Medicine, Landeskrankenhaus Feldkirch; Division of Nephrology and Dialysis,4 Third Department of Medicine, Krankenhaus der Barmherzigen Schwestern vom Hl. Kreuz, Wels; Clinical Division of Nephrology and Dialysis,5 Medical University of Graz; Division of Nephrology and Dialysis,6 First Department of Medicine, A.ö. Krankenhaus St. Pölten; Division of Nephrology and Dialysis,7 Department of Medicine III, Medical University of Vienna, Austria
a Members of the Austrian Study Group for Prevention of Peritoneal Catheter-Associated Infections: Klaus Arneitz, Andrea Karner, Landeskrankenhaus Villach; Rene Artes, Erich Wolf, Hanusch–Krankenhaus; Martin Auinger, Andrzej Pawlak, Krankenhaus Hietzing, Wien; Johannes Fraberger, Sabine Hofbauer, Landesklinikum Waldviertel, Horn; Georg Galvan, Hermann Salmhofer, Birgit Pichler, Melanie Wazel, Salzburger Landeskliniken, Salzburg; Manfred Gruber, Anni Thonhofer, Landeskrankenhaus Bruck an der Mur; Alfred Hager, Sabine Malajner, Krankenhaus Wiener Neustadt; Susanne Heiss, Thomas Braunsteiner, Monika Zweifler, Donauspital–SMZ Ost, Wien; Paul König, Michael Rudnicki, Klinische Abteilung für Nephrologie, Medizinische Universität Innsbruck; Richard Kogler, Bezirkskrankenhaus Lienz; Dietmar Kohlhauser, Tatjana Wiesinger, Landeskrankenhaus Rottenmann; Gertrude Kopriva–Altfahrt, Elisabeth Moser, Wilhelminenspital Wien; Peter Kotanko, Herbert Loibner, Helga Nitz, Krankenhaus der Barmherzigen Brüder Graz; Hans Joachim Miska, René Wenzel, Monika Wölfler, Krankenhaus Zell am See; Michael Mündle, Heimo Breuss, Landeskrankenhaus Feldkirch; Bertram Hölzl, Wolfgang Oberortner, Landesklinik St.Veit im Pongau; Friedrich Prischl and PD nurses team, Klinikum der Kreuzschwestern, Wels; Bernhard Schmekal, Eva-Maria Riener, Allgemeines Krankenhaus Linz; Johannes M. Roob, Waltraud Wonisch, Medizinische Universität Graz; Rudolf Vikydal, Landeskrankenhaus Steyr; Andreas Vychytil, Barbara Frank, Medizinische Universität Wien; Clemens Wieser, Landeskrankenhaus Klagenfurt; Martin Wiesholzer, Karin Pokorny, Zentralklinikum St.Pölten
Correspondence to: A. Vychytil, Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. andreas.vychytil{at}meduniwien.ac.at
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).
KEY WORDS: Exit-site infection; tunnel infection; povidone iodine; sodium hypochlorite; tunnel ultrasonography; mupirocin; film dressing; gauze dressing.
Received 21 December 2007; accepted 8 September 2008.
This article has been cited by other articles:
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  B. Piraino Mupirocin for preventing exit-site infection and peritonitis in patients undergoing peritoneal dialysis. Was it effective? Nephrol. Dial. Transplant., February 1, 2010; 25(2): 349 - 352. [Full Text] [PDF]
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