Authors (including presenting author) :
TH Ip, PK Yii, KM Chan, MY Wong, HP Cheung, CY Wong, TL Ho
Affiliation :
Hemodialysis Center, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Patients who acquire peritoneal dialysis (PD) catheter related infection, including exit site infection (ESI) and tunnel infection, require additional nursing care, clinic attendance or hospitalization for intravenous antibiotic treatment. Refractory ESI may delay commencement of PD or even require catheter removal and temporary hemodialysis support. Early assessment and intervention of surgical wound is paramount to reduce ESI.
Objectives :
ERASE (Early Re-Assessment to reduce post-Surgical Exit site infection) program after Tenckhoff catheter insertion was implemented in our center since 1/8/2023, aiming to provide early assessment and intervention to prevent severe ESI requiring antibiotic or other interventions.
Methodology :
Conventionally, all patients were advised to keep wound intact after PD catheter insertion and scheduled to attend renal center for exit site dressing weekly for consecutive 2 weeks. Bathing was allowed if wound healed after 2 weeks. With implementation of ERASE program from 1/8/2023, patients were scheduled to have wound review every 4-5 days during the early post-operative period until exit site healed. Early ESI was defined as presence of purulent discharge from the exit site wound requiring antibiotic treatment within 14 days after operation. Patients’ outcome from 1/8/2023 – 17/12/2024 were reviewed and we compared data from 1/1/2022 to 30/6/2023 prior launching ERASE program.
Result & Outcome :
From 1/1/2022 to 30/6/2023, there were 111 patients requiring PD catheter insertion. The median age of the patients was 62 years old. 71% of them was male and 63% had diabetes mellitus. Early ESI was detected in 10 patients (9.1%). One of the patient required prolonged intravenous antibiotic for 14 days. In the period from 1/8/2023 to 17/12/2024 after launching the ERASE program, 80 patients were reviewed. The median age of the patients was 61.5 years old. 49% of them was male and 56% had diabetes mellitus. Early ESI was greatly reduced from 9.1% to 3.8% (3 out of 80 patients). None of the patients required catheter removal in the two cohorts. The relative risk reduction of developing Tenckhoff ESI after the program was 0.58 (P=0.18). This translated to a significant reduction of day cases to our dialysis center for wound care or antibiotics injection and the patients’ outcomes were improved.
