Exit site infection in peritoneal dialysis : predictive factors for adverse outcome

Infection-related complications in patients on peritoneal dialysis (PD) is a leading complication. Our aim was to evaluate the type and natural course of ESI events in a cohort of PD treated in last decade of our PD program. Registry data of ESI events (n=126, in 74 patients) were retrieved. ESI protocols followed standard international guidelines. A systematic quality control is performed.                The median follow-up was 29.1 (14.0-47.4) months. In this population the adverse outcomes of TI rate and peritonitis rate was 0.12 and 0.13 patient/year, respectively. Male sex (0.048), older age (0.007) and Staphylococcus aureus (SA) agent (0.006) were predictive of TI while non-optional PD and lower levels of albumin were predictive of peritonitis.  After grouping the ESI events according to the date of the occurrence of infection (group 1: 2008 to 2012, group 2: 2013 to 2017 and group 3: 2018) a substantial increase of TI in 2018 was evident (P <0.001 when comparing group 3 vs 1 and 0.005 when comparing group 2 and 3).               When ESI occurs simultaneous with TI, the probability of not reaching cure is 65%. Drop-out occurred in 50% of ESI without peritonitis vs 86% with peritonitis (P <0.001). SA is the microorganism most implicated in the failure to heal (P 0.002) and drop-out (P 0.010). In spite of a number of efforts to reduce ESI, a regular audit still point to the need for protocols review in order to avoid adverse outcomes. Focused training of patients is mandatory but also prophylaxis and antibiotic protocols deserve improvement.