Exitsiteinfektio

Exitsiteinfektio is a localized infection at the exit site of a peritoneal dialysis catheter. In peritoneal dialysis (PD), infections can involve the exit site, the subcutaneous tunnel, or the peritoneal cavity; exit-site infections specifically affect the skin around the catheter entry point and may precede deeper infections if not treated.

Clinical features include redness, warmth, tenderness, crusting or discharge at the exit site, sometimes with swelling or itching. Systemic symptoms such as fever are uncommon but can occur with more extensive infection.

Most cases are caused by skin flora, especially Staphylococcus aureus and Staphylococcus epidermidis; Pseudomonas aeruginosa and other Gram-negative bacteria can cause more aggressive disease, particularly in patients with repeated infections or inadequate exit-site care.

Diagnosis is based on the appearance at the exit site and may be supported by culture of the discharge or swab. It is important to distinguish exit-site infection from tunnel infection, which involves the subcutaneous tract and requires different management.

Treatment begins with improved exit-site care and topical antibiotics applied to the exit site, such as mupirocin or gentamicin, typically for 1–2 weeks. If there is poor response, signs of systemic infection, or infection with Pseudomonas, systemic antibiotics with appropriate coverage are used. In refractory cases or when the tunnel is involved, catheter removal or exchange may be necessary.

Prevention focuses on strict aseptic technique during catheter care, regular cleansing with antiseptic solutions, proper hand hygiene, routine monitoring of the exit site, and patient education to recognize early signs of infection.

Exitsiteinfektio is the Finnish spelling used in clinical practice to describe an exit-site infection in peritoneal dialysis patients.