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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention of such is important in reducing patient morbidity and mortality. The International Society for Peritoneal Dialysis (ISPD) recommend that the overall peritonitis rate should be no more than 0.40 episodes per year at risk and the PD catheter insertion-related peritonitis no more than 5%. In order to minimize bacterial colonization of the exit and tunnel during the early postoperative period (three weeks) and healing period (six weeks), the dressing procedure is carried out as a sterile procedure.
Retrospective cohort including 121 patients with PD catheter implantation (surgical and percutaneous) from January to December 2011 and 59 patients from January to December 2021 in the PD clinic of Regional Hospital Valentin Gomez Farias in México. We compared the PD catheter insertion-related peritonitis rate in first two months postoperatively. Independent variable was dressing procedure, implemented in our PD clinic in 2014. The PD catheter postop dressing included the use Exsept® 10% cleaning solution (hypochlorite ion and hypochlorous acid) and mupirocin ointment in the exit site, then it was covered with gauze and breathable fixation (hypafix) every week until complete 21 days. Then patients could take shower and continue to standard care without dressing, cleaning only with antiseptic soap and mupirocin ointment.
The PD catheter insertion-related peritonitis rate in 2011 was 0.20 vs 0.06 in 2021 in first two months postoperatively (Figure 1). In 2011 25 (20%) patients were present a PD catheter insertion-related peritonitis episode vs 4 (6%) patients in 2021. Catheter-related peritonitis were presented in 4 patients in 2011 compared to no episode in 2021.
The correct implementation of dressing procedure in chronic PD catheter exit site postoperative care reduce the PD catheter insertion-related peritonitis. Therefore, should be standardized the technique of postoperative dressing worldwide PD units.