The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients.
BACKGROUND
Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4 cm instead of 2 cm internal to the exit-site.


METHODS
We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 ± 16.8) treated for 3337 months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.


RESULTS
31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12 months and 61.8% at 36 months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months.


CONCLUSIONS
Positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.
['Nardelli|Luca|L|http://orcid.org/0000-0002-1749-7100', 'Scalamogna|Antonio|A|', 'Messa|Piergiorgio|P|']
D002408:Catheters, Indwelling D002675:Child, Preschool D005260:Female D006801:Humans D015994:Incidence D008297:Male D010530:Peritoneal Dialysis D010531:Peritoneal Dialysis, Continuous Ambulatory D010538:Peritonitis
Tunnel infection Peritoneal dialysis (PD) Peritonitis Catheter insertion End-stage renal disease (ESRD) Exit-site infection (ESI) PD complications