PD Exit Site Infection — ESENeph MCQ

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HardPeritoneal DialysisPD Exit Site InfectionESENeph

A peritoneal-dialysis patient has an uncomplicated MSSA exit-site infection without tunnel involvement or peritonitis. Oral flucloxacillin is started according to susceptibility. What follow-up and duration plan reflects the 2023 ISPD update?

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Correct answer: B — Review early and shorten treatment after confirmed resolution

The best answer is “Review early and shorten treatment after confirmed resolution”. The update moves away from an obligatory 2-week course for every exit-site infection: oral anti-staphylococcal treatment is reviewed within about 1 week and may stop at 7–10 days when resolution is confirmed. “Remove the catheter immediately despite early clinical response” is less appropriate because catheter intervention is reserved for infection that is refractory or associated with deeper infection or peritonitis “Give intraperitoneal vancomycin for 3 weeks” is less appropriate because intraperitoneal therapy is not required for an isolated susceptible MSSA exit-site infection “Use topical mupirocin as the complete treatment course” is less appropriate because topical prophylaxis does not replace systemic treatment of established infection “Continue flucloxacillin for 6 weeks without interim examination” is less appropriate because ISPD emphasises early clinical review and response-guided duration to avoid unnecessarily prolonged therapy

Reference: ISPD catheter-related infection recommendations 2023: https://pubmed.ncbi.nlm.nih.gov/37232412/