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PD Exit Site Infection — RACP Adult Medicine MCQ

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HardNephrologyPD Exit Site InfectionRACP Adult Medicine

A peritoneal-dialysis patient has purulent Staphylococcus aureus exit-site drainage without cloudy effluent. After two weeks of susceptibility-directed therapy, discharge persists and ultrasound shows fluid tracking around the superficial cuff. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Plan catheter source control and maintain culture-directed antistaphylococcal therapy

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

D is correct because persistent drainage plus cuff involvement predicts poor response to antibiotics alone and requires PD-team assessment for catheter salvage or timely replacement. E may be reasonable for a slowly improving uncomplicated exit-site infection, but not demonstrated cuff disease. A treats an unproven peritonitis while missing the catheter focus. B cannot remove infection around the cuff. C can be considered in selected cases, but the timing and feasibility require source-control planning. Tunnel ultrasound is useful when clinical extension is occult.

Reference: Australian CARI Guidelines, PD catheter-related infection: exit site and tunnel: https://www.cariguidelines.org/guidelines/dialysis/peritonitis-treatment-and-prophylaxis/pd-catheter-related-infection-exit-site-and-tunnel/; International Society for Peritoneal Dialysis catheter-related infection recommendations 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC10719648/