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Published on Jul 4, 2021
A 39 -year-old peritoneal dialysis (PD) patient with ESRD from DM nephropathy on PD without complications for 2 years. On physical examination, a small area of erythema was noted at the catheter exit site . he denies pain, discharge, pruritus, or cloudy peritoneal fluid. PD fluid analysis shows a dialysate showed no cells. Cultures of the pericatheter skin were obtained and was negative . He recently has switched to Mupirocin application of as antiseptic solution. Follow
Up exam 5 days later showed expanding erythematous rash in the pericatheter area on exam abdomen normal exam with no tenderness with intact bowel sounds. An ultrasound of the PD catheter tunnel showed no signs of inflammation. A 69-year-old peritoneal dialysis (PD) patient with end-stage renal disease due to hypertensive nephropathy presented for a routine visit. He had been treated with PD without complications for 3 years. On physical examination, a small area of redness was noted at the catheter exit site (Fig 1A). The patient denied pain, discharge, pruritus, or cloudy peritoneal fluid. Analysis of a dialysate sample showed no cells. Cultures of the pericatheter skin were obtained, and the patient was reminded to conduct a daily exit-site care routine, including application of a standard antiseptic solution. Three days later, the patient presented with an expanding erythematous rash in the pericatheter area (Fig 1B). Physical examination otherwise was unremarkable, including a nontender abdomen with intact bowel sounds. An ultrasound of the PD catheter tunnel showed no signs of inflammation. Because culture results of the pericatheter skin were negative for bacteria and fungi, empiric antibiotic therapy was started. Despite this treatment, signs of exit-site inflammation progressively worsened , and his signs of exit-site inflammation progressively worsened
Next step in management

1) remove PD catheter due to tunnel infection suspicion
2) repeat another course of systemic antibiotic and add rifamipin
3) skin test for mupirocin allergy
4) treat with IP antibiotic for culture negative peritonitis for 3 weeks

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Answer is choice 3

1) PD catheter is removed for tunnel infection, fungal /MRSA/ psedudomonas peritontis and repeat infection with same organism despite antibiotic treatment
2) exit site culture is negative and repeat antibiotic not needed
3) skin test to look for allergy is next best step as MUpirocin can have skin allergy
4) PD fluid clear with no abdominal
Signs so need to use IP anti