1887

Chapter 17 : Infections Related to Hemodialysis and Peritoneal Dialysis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in
Zoomout

Infections Related to Hemodialysis and Peritoneal Dialysis, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555818067/9781555811778_Chap17-1.gif /docserver/preview/fulltext/10.1128/9781555818067/9781555811778_Chap17-2.gif

Abstract:

Hemodialysis and peritoneal dialysis provide life-sustaining therapy for patients with end-stage renal disease (ESRD). Peritoneal dialysis requires the regular exchange of dialysate within the peritoneum. The dialysate contains high concentrations of glucose, which create an osmotic force to move fluid into the peritoneal cavity. Immunosuppression can also be a direct result of the dialysis process. During peritoneal dialysis, the regular exchange of dialysate causes the dilution and removal of white cells, along with factors such as cytokines, immunoglobulins, and opsonins. The standard material for the construction of bridge grafts is polytetrafluoroethylene (PTFE). PTFE is hydrophobic, inert, and thought to resist infection. Central venous catheters (CVCs) play a vital role in the maintenance of vascular access for many patients. Tunneling and dacron cuffs are designed to prevent infection of hemodialysis CVCs. Empiric treatment of catheter-related bloodstream infection (CR-BSI) should cover gram-positive (e.g., vancomycin, cefazolin, cloxacillin) and gram-negative (e.g., gentamicin) organisms while awaiting culture results. Vancomycin should be used if the prevalence of methicillin-resistant staphylococci is high. Blood cultures should be repeated periodically during and immediately after completion of therapy to monitor effectiveness. Infections related to peritoneal dialysis are broadly classified as peritonitis or exit-site/ tunnel infection. Peritonitis caused by pseudomonal or xanthomonal organisms is generally more serious than that caused by other gram-negative bacteria. Catheter loss has been reported to complicate 16.3% of episodes of peritonitis and 21% of exit-site and tunnel infections.

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17

Key Concept Ranking

Coronary Artery Disease
0.42226487
Urinary Tract Infections
0.42098138
Catheter-Related Bloodstream Infections
0.41421103
0.42226487
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of Figure 1
Figure 1

Location of exit-site infection and tunnel infection in typical hemodialysis central venous catheter. Tunnel infection can be defined as signs of infection extending beyond a 2-cm radius of the exit site or, alternatively, signs of infection that extend proximal to the Dacron cuff.

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 2
Figure 2

Location of exit site, tunnel infection, and peritonitis in a typical peritoneal dialysis catheter. Tunnel infection occurs when infection extends beyond the superficial cuff. Peritonitis occurs when infection enters into the peritoneal cavity.

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3
Figure 3

Randomized studies of carriage eradication to prevent peritoneal exit-site infection. For intranasal mupirocin. the treatment was mupirocin twice daily to the nose for 5 consecutive days every 4 weeks. For first oral rifampin study (third column from left), the treatment was 300 mg twice daily for 5 days of each 12-wcek interval. For the second oral rifampin study (fifth and sixth columns from the left), the rifampin was given as 600 mg daily for 5 days every 3 months, and the mupirocin ointment was applied to the exit site daily.

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 4
Figure 4

The Y-conncct system for peritoneal dialysis. The patient connects the peritoneal dialysis catheter to the Y connector. One arm of the Y connects to the fresh bag of dialysis solution while the other arm is connected to the previously used dialysis bag. The first step after the spike is to flush a small amount of the new dialysis solution into the old dialysis bag. The remainder is instilled into the peritoneal cavity. This “flush before fill” technique significantly reduced peritonitis rates. An additional modification is to have a separate drainage bag pre-attached to the Y connector, rather than to the previously used bag. to minimize the number of connections performed by the patient. The solid triangle (▲) represent a clamped dialysis line and the arrows represent the direction of dialysis flow. Adapted with permission from reference . Copyright 1999 UpToDate. Inc.

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 5
Figure 5

Recommended care path for the diagnosis and treatment of peritoneal dialysis-related peritonitis. The diagram is a general recommendation for diagnoses and treating peritonitis. Management should be reassessed based on actual sensitivities and the clinical status of the patient. Catheter removal may be required to resolve infection. For antibiotic dosages see Table 11 . Adapted and redrawn with permission ( ).

Citation: Oliver M, Schwab S. 2000. Infections Related to Hemodialysis and Peritoneal Dialysis, p 345-372. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555818067.chap17
1. Almirall, J.,, J. Gonzalez,, J. Relio,, J. M. Campistol,, J. Montoliu,, Puig de la Bellacasa. L. Revert,, and J. M. Gatell. 1989. Infection of hemodialysis catheters: incidence and mechanisms. Am. J. Nephrol. 9: 454 459.
2. Al-Wakcel, J. S.,, A. H. Milwalli,, G. H. Malik,, S. Huraib,, S. Al-Mohaya,, H. Abu-Aislia,, and N. Memon. 1998. Dual-lumen femoral vein catheterization as vascular access for hemodialysis—a prospective study. Angiology 49: 557 562.
3. Barron, P. T.,, J. L. Wellington,, J. W. Lorimer,, C. W. Cole,, and D. Moher. 1993. A comparison between expanded polytetrafluoroethylene and or hemodialysis access. Can. J. Surg. 36: 184 186.
4. Bazzato, G.,, S. Landini,, U. Coli,, S. Lucatello,, A. Fracasso,, and M. Moracchiello. 1980. A new technique of continuous ambulatory peritoneal dialysis (CAPD): double-hag system for freedom to the patient and significant reduction of peritonitis. Clin. Nephrol. 13: 251 254.
5. Bcathard. G. A. 1999. Management of bacteremia associated with tunneled cuffed hemodialysis catheters. J. Am. Soc. Nephrol. 10: 1045 1049.
6. Bennion, R. S.,, J. R. Hiatt,. R. A. Williams,, and S. E. Wilson. 1985. A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery. J. Curdiovasc. Surg. 26: 270 274.
7. Bernardini, J.,, B. Piraino,, J. Holley,, J. R. Johnston,, and R. Lutes. 1996. A randomized trial of Staphylococcus aureus prophylaxis in peritoneal dialysis patients: mupirocin calcium ointment 2'7c applied to the exit site versus cyclic oral rifampin. Am. J. Kidney Dis. 27: 695 700.
8. Bezerra, D., A. M. B. Silva,. J. S. Caramori,, M. F. Sugizaki,, T. Sadatsune,, A. C. Montclli,, and P. Barretti. 1997. The diagnostic value of Gram slain for initial identification of the etiologic agent of peritonitis in CAPD patients. Peril. Dial. Int. 17: 269 272.
9. Blake, P. G.,, S. Huraib,. G. Wu,, and P. R. Lildall. 1990. The use of dual lumen jugular venous catheters as definitive long term access for haemodialysis. Int. J. Artif. Organs 13: 26 31.
10. Bonomo. R. A.,, I. Rice,, C. Whalen,. D. Linn,, E. Eckstein,, and D. M. Shlaes. 1997. Risk factors associated with permanent access-site infections in chronic hemodialysis patients. Infect. Control Hosp. Epidemiol. 18: 757 761.
11. Bour, E. S.,, A. S. Weaver,. H. C. Yang,, and R. R. Gifford. 1990. Experience with the double lumen Silastic catheter for hemoaccess. Surg. Gynecol. Obstet. 171: 33 39.
12. Bunke, C. M.,, M. E. Brier,, and T. A. Golper. 1997. Outcomes of single organism peritonitis in peritoneal dialysis: gram negatives versus gram positives in the Network 9 Peritonitis Study. Kidney Int. 52: 524 529.
13. Bunke, M.,, M. E. Brier,, and T. A. Golper. 1994. Culture-negative CAPD peritonitis: the Network 9 Study. Adv. Perit. Dial. 10: 174 178.
14. Bunke, M.,, M. E. Brier,, and T. A. Golper. 1995. Pseudomonas peritonitis in peritoneal dialysis patients: the Network 9 peritonitis study. Am. J. Kidney Dis. 25: 769 774.
14a.. Burkart. J. M., 1999. Pathophysiology and prevention of peritonitis in continuous peritoneal dialysis. In B. D. Rose (ed.). UptoDate. UpToDate. Wellesley, Mass..
15.Canada-USA Peritoneal Dialysis Study Group. 1996. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J. Am. Soe. Nephrol. 7: 198207.
16. Canadian CAPD Clinical Trials Group. 1989. Peritonitis in continuous ambulatory peritoneal dialysis (CAPD): a multi-centre randomized clinical trial comparing the Y connector disinfectant system to standard systems. Canadian CAPD Clinical Trials Group. Peril. Dial. Int. 9: 159163.
17. Canaud, B.,, J. J. Beraud,, H. Joyeux,, and C. Mion. 1986. Internal jugular vein canntilation with two silicone rubber catheters: a new and safe temporary vascular access for hemodialysis. Thirty months' experience. Artif. Organs 10: 397 103.
18. Cappello, M.,, P. L. De,, G. Bastin,, F. Prospert,, C. Delcour,, C. Thaysse,. M. Dhaene,, J. L. Vanher-weghem,, and P. Kinnaert. 1989. Central venous access for haemodialysis using the Hickman catheter. Nephrol. Dial. Transplant. 4: 988 992.
l8a.. Capdevila. J. A.,. A. Segaría,, A. M. Planes,, M. Ramirez-Arellano,. A. Pahissa,. L. Piera,. and J. M. Martinez-Vazquez. 1993. Successful treatment of haemodialysis catheter-related sepsis without catheter removal. Nephrol. Dial. Transplant. 8: 231 234.
19. Carde, P.,, M. F. Cosset-Delaigue,, A. Laplanche,, and I. Cbareau. 1989. Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. Eur. J. Cancer Clin. Oncol. 25: 939 944.
20. Carlisle, E. J.,, P. Blake,, F. McCarthy,, S. Vas,, and R. Uldall. 1991. Septicemia in long-term jugular hemodialysis catheters; eradicating infection by changing the catheter over a guidewire. Int. J. Artif. Organs 14: 150 153.
21. Cheesbrough, J. S.,, R. G. Finch,, and R. P. Burden. 1986. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J. Infecí. Dis. 154: 579 589.
22. Churchill, D. N.,, D. W. Taylor,, R. J. Cook,, P. LaPlante,, P. Barre,, P. Cartier,, W. P. Fay,, M. B. Goldstein,, K. Jindal,, and H. Mandin. 1992. Canadian Hemodialysis Morbidity Study. Am. J. Kidney Dis. 19: 214 234.
23. Cohen, G.,, M. Haag-Weber,, and W. H. Horl. 1997. Immune dysfunction in uremia. Kidney Int. 62( Suppl.): S79 S82.
24. Dahlberg, P. J.,, W. A. Agger,, J. R. Singer,, W. R. Yutue,, K. L. Newcomer,, A. Schaper,, and B. L. Rooney. 1995. Subclavian hemodialysis catheter infections: a prospective, randomized trial of an attachable silver-impregnated cuff for prevention of catheter-related infections. Infect. Control Hosp. Epidemiol. 16: 506 511.
25. Dahlberg, P. J.,, W. R. Yiituc,, and K. L. Newcomer. 1986. Subclavian hemodialysis catheter infections. Am. J. Kidney Dis. 7: 421 427.
26. De Cubber, A.,, C. Dewolf,, N. Lameire,, M. Schugers,, and S. Ringoir. 1978. Single needle hemodialysis with the double headpump via the subclavian vein. Dial. Transplant. 7: 1261 1263.
27. De Meester, J.,, R. Vanholder,, R. J. De,, and S. Ringoir. 1994. Factors and complications affecting catheter and technique survival with permanent single-lumen dialysis catheters. Nephrol. Dial. Transplant. 9: 678 683.
28. Descamps-Latscha, B.,, and L. Chatenoud. 1996. T cells and B cells in chronic renal failure. Semin. Nephrol. 16: 183 191.
29. Dobkin J. F.,, M. H. Miller,, and N. H. Steigbigel. 1978. Septicemia in patients on chronic hemodialysis. Ann. Intern. Med. 88: 28 33.
30. Dryden, M. S.,, A. Samson,, H. A. Ludlam,, A. J. Wing,, and I. Phillips. 1991. Infective complications associated with the use of the Quinton 'Permcath' for long-term central vascular access in haemodialysis. J. Hosp. Infect. 19: 257 262.
31. Eklund, B. H.,, E. O. Honkanen,, A. R. Kala,, and L. E. Kyllonen. 1994. Catheter configuration and outcome in patients on continuous ambulatory peritoneal dialysis: a prospective comparison of two catheters. Peril. Dial. Int. 14: 70 74.
32. Eklund, B. H.,, E. O. Honkanen,, A. R. Kala,, and L. E. Kyllonen. 1995. Peritoneal dialysis access: prospective randomized comparison of the Swan neck and Tenckhoff catheters. Perit. Dial. Int. 15: 353 356.
33. Favazza, A.,, R. Petri,, D. Montanaru,, G. Boscutti,, F. Bresadola,, and G. Mioni. 1995. Insertion of a straight peritoneal catheter in an arcuate subcutaneous tunnel by a tunneler: long-term experience. Perit. Dial. Int. 15: 357 362.
34. Flowers, R. H.,, K. J. Schweitzer,, R. F. Kopel,, M. J. Fisch,, S. I. Tucker,, and B. M. Farr. 1989. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. A randomized, controlled trial. JAMA 261: 878 883.
35. Fried L.,, S. Abidi,, J. Bernard™,, J. R. Johnston,, and B. Piraino. 1999. Hospitalization in peritoneal dialysis patients. Am. J. Kidney Dis. 33: 927 933.
36. Fried, L. F., J. Bernardini, J. R. Johnston, and B. Piraino. 1996. Peritonitis influences mortality in peritoneal dialysis patients. J. Am. Soc. Nephrol. 7: 2176 2182.
37. Gibson, S. P.,, and D. Mosquera. 1991. Five years experience with the Quinton Permcath for vascular access. Nephrol. Dial. Transplant. 6: 269 274.