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Thread: exit site irritation
December 1, 2004, 07:30 AM #1Anonymous Guest
exit site irritation
I have a patient that developed pseudomonas at his exit site about 2 months after his start on pd. We used IP and PO antibiotics to irradicate it.
I have recultured it and it is free of pathogens.
The site looks and feels better but the patient is concerned that it is still pink and a little irritated. He has sensitive skin - the kind that " pinks up" quickly with tape or merely cleansing. He is using betadine swabs for daily care and alternates this with soap and water.
Does anyone have experience with a soothing ointment or cream that will not degrade the catheter? Bactroban wouldn't be a good choice on this.
December 8, 2004, 01:56 PM #2Anonymous Guest
Exit site irritation
Light pink and pink coloration is within the normal range for a healthy PD catheter exit site. After a chronic infection, it may take months to get back to normal skin color. Some patients always have pink coloration. (See Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. Peritoneal Dialysis International, 16(Suppl 3):S32-50, 1996.)
We've had patients with sensitivity (not allergy) to the povidone iodine solution and scrub. You might try eliminating that or switching to something else.
Re: creams, the University of Pittsburgh group has recently presented results of a study using gentamicin cream for exit site care and found it to be more effective than mupirocin ointment.
December 29, 2004, 06:41 PM #3Anonymous Guest
PD exit site irritation
We've had good results using bottled water (3/4 cup), white vinegar (1/2 cup) and 1 3/4 tsp table salt, shake until dissovled and pour into a clean squirt bottle. Should feel soothing, if burns discontinue use. This has worked with our pseudomonas pts.
January 3, 2005, 10:46 AM #4Anonymous Guest
The Hong Kong Journal of Nephrology, 2001:3(1):38-40 has an article titled "Use of distilled white vinegar dressing supplemental to oral antibiotics in the managment of Pseudomonas aeruginosa exit site infection in continuous ambulatory peritoneal dialysis". It is a retrospective review of use of diluted (1:1) distilled white vingar used with a 2-week course of ciproflaxacin. The pH is 3, and the theory is that the acidic environment prevents growth of the microorganisms. They achieved a 97% eradication with no relapse. So I think its safe to assume that prophylactic use of a vinegar rinse would reduce the risk of a new or recurrent Pseudomonas infection.
May 12, 2005, 08:44 AM #5Anonymous Guest
Can anyone tell me more about gentamicin cream use on exit sites?
May 13, 2005, 06:12 PM #6Resource/Policy Associate Registered User
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The following is an abstract that I found on PubMed. It looks like it might be helpful.
J Am Soc Nephrol. 2005 Feb;16(2):539-45. Epub 2004 Dec 29.
Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients.
Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, Piraino B.
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Infection is the Achilles heel of peritoneal dialysis. Exit site mupirocin prevents Staphylococcus aureus peritoneal dialysis (PD) infections but does not reduce Pseudomonas aeruginosa or other Gram-negative infections, which are associated with considerable morbidity and sometimes death. Patients from three centers (53% incident to PD and 47% prevalent) were randomized in a double-blinded manner to daily mupirocin or gentamicin cream to the catheter exit site. Infections were tracked prospectively by organism and expressed as episodes per dialysis-year at risk. A total of 133 patients were randomized, 67 to gentamicin and 66 to mupirocin cream. Catheter infection rates were 0.23/yr with gentamicin cream versus 0.54/yr with mupirocin (P = 0.005). Time to first catheter infection was longer using gentamicin (P = 0.03). There were no P. aeruginosa catheter infections using gentamicin compared with 0.11/yr using mupirocin (P < 0.003). S. aureus exit site infections were infrequent in both groups (0.06 and 0.08/yr; P = 0.44). Peritonitis rates were 0.34/yr versus 0.52/yr (P = 0.03), with a striking decrease in Gram-negative peritonitis (0.02/yr versus 0.15/yr; P = 0.003) using gentamicin compared with mupirocin cream, respectively. Gentamicin use was a significant predictor of lower peritonitis rates (relative risk, 0.52; 95% confidence interval, 0.29 to 0.93; P < 0.03), controlling for center and incident versus prevalent patients. Gentamicin cream applied daily to the peritoneal catheter exit site reduced P. aeruginosa and other Gram-negative catheter infections and reduced peritonitis by 35%, particularly Gram-negative organisms. Gentamicin cream was as effective as mupirocin in preventing S. aureus infections. Daily gentamicin cream at the exit site should be the prophylaxis of choice for PD patients.Beth Witten MSW ACSW LSCSW
Medical Education Institute, Inc.
January 12, 2011, 10:16 PM #7Junior Member Registered User
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January 14, 2011, 08:31 AM #8Moderator Registered User
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Pretty sure we don't have that in the US, Alan, but with the Internet, many things are possible... Dr. Agar is a big advocate of Medihoney, which is sold in Australia but much harder to get elsewhere. That might also be a possibility.
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