Water avoidance and modification of exit-site care with stoma bag results in reduced exit-site infection rate in peritoneal dialysis patients

Aim: Infection is one of the drawbacks associated with peritoneal dialysis (PD) and is related to significant morbidity. After we experienced an increase in exit-site infection (ESI) rate, mostly derived from environmental and water-derived organisms, we hypothesized that preventing exit-site exposure to water and narrowing local antibiotics range will reduce colonization and subsequent infection. Materials and methods: In this study, we aimed to estimate PD-related infections after exit-site policy change in a prospective study cohort of 27 participants compared to a control group of 58 participants. The modification of exit-site care consisted of applying a stoma bag during daily shower to prevent water exposure and conversion of local antibiotic from gentamycin to mupirocin. Primary outcome was catheter-related infection. Secondary outcomes were peritonitis rate and infection-related outcomes. Results: The study group had a significantly lower ESI and ESI from environmental organisms' free probability. Rate of ESI from all causes was 0.054 ± 0.09 vs. 0.031 ± 0.09 episodes per patients' month for the control and study group, respectively (p = 0.049). Rate of environmental organism-related ESI was 0.047 ± 0.07 vs. 0.015 ± 0.08 episodes per patients' months for control and study group, respectively (p = 0.042). A higher risk of ESI from all organisms, and specifically from environmental organisms, was associated with being in the control group and a longer follow-up period. Rate of peritonitis was similar in both groups. Conclusion: The adjusted exit-site care policy significantly lowered ESI incidence. Avoidance of water exposure may have contributed to lessen bacterial colonization.