What is the most appropriate time frame to use when defining relapse, recurrent and repeat exit site infection?

Questions About PD

Charon, Nurse from Saudi Arabia asked
What is the most appropriate time frame to use when defining relapse, recurrent and repeat exit site infection?

1 answer

Nurse Canada with members of the ISPD Nurse Committee August 17, 2022

Thank you for your question. PD catheter exit-site infection is a well recognized risk factor for the development of PD peritonitis. As far as we are aware, this terminology of “relapsing, recurrent and repeat” while commonly used for defining episodes of peritonitis, has only some initial degree of use for classifying PD catheter exit-site infections.
According to the authors of the most recent (2017) ISPD guidelines on “Catheter-related infection recommendations”:
Catheter removal and insertion

  • The authors recommend simultaneous removal and reinsertion of the dialysis catheter with a new exit site under antibiotic coverage in PD patients with refractory exit-site or tunnel infection without peritonitis, defined as failure to respond after 3 weeks of effective antibiotic therapy.
  • The authors suggest removal of the dialysis catheter in PD patients with exit-site infections that progress to, or occur simultaneously with, peritonitis (1, page 148).

Of interest, authors of a recently published retrospective, cohort study from a single centre in the U.K. have proposed that repeat exit-site infections should be defined as: “2 or more exit-site infections with the same organism within a 12-month period and an initial positive response to antibiotic therapy” (2, page 344).
Clearly, this is an area that would benefit from further research and refining of definitions for classifying PD catheter exit-site infections. We trust this information is helpful to you.
1. Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, Ito Y, Kazancioglu R, Moraes T, Van Esch S, Brown EA. ISPD catheter-related infection recommendations: 2017 update. Peritoneal Dialysis International. 2017 Mar;37(2):141-54. Available at: https://www.researchgate.net/profile/Thyago Moraes/publication/315909564_ISPD_Catheter-Related_Infection_Recommendations_2017_Update/links/58f6ce030f7e9b67a34b9cd9/ISPD-Catheter-Related-Infection-Recommendations-2017-Update.pdf
2. Beckwith H, Clemenger M, McGrory J, Hisole N, Chelapurath T, Newbury S, Corbett RW, Brown EA. Repeat peritoneal dialysis exit-site infection: definition and outcomes. Peritoneal Dialysis International. 2019 Jul;39(4):344-9.


Please login to submit an answer