Peritoneal catheter exit-site and tunnel infections.

Peritoneal catheter exit-site and tunnel infections may lead to peritonitis and catheter loss. Exit-site infections are diagnosed when there is pericatheter erythema and/or purulent drainage. Staphylococcus aureus is the most common cause of both exit-site and tunnel infections. S. aureus nasal carriage is an important risk factor for S. aureus catheter infections. Few other risk factors for catheter infections have been identified. Treatment of catheter infections consists of antibiotic therapy, often prolonged, as well as intensification of exit-site care. Refractory cases may resolve with revision of the tunnel and exit-site with removal of the superficial cuff, but some patients undergoing this procedure will develop peritonitis. Once peritonitis develops from a tunnel infection, the catheter should be replaced. Research on prevention of catheter infections has focused on three areas: antibiotic prophylaxis, exit-site care, and new catheter designs. Several antibiotic protocols, including intranasal mupirocin, cyclical oral rifampin, and exit-site mupirocin, are effective in decreasing S. aureus catheter infections and should be used more widely. New catheter designs may, in the future, prove to further diminish catheter infection and loss, but there are insufficient data at this time to show superiority of one catheter over another.