Exit-site infection definition and treatment?

• A. Exit-site infection that presents with redness at the exit site and no drainage.
• B. Peritoneal infection with cloudy effluent.
• C. Exit-site infection that presents only with itching but no drainage.
• D. Infection at catheter exit site with redness or purulent drainage; treated with topical antibiotic and exit-site care, with systemic antibiotics if needed.

Answer: (D)

Exit-site infection means infection at the catheter exit site, with signs such as redness around the exit and/or purulent drainage. This is distinct from issues like itching alone or redness without drainage, which don’t meet the criteria for exit-site infection, and from peritonitis, which presents as a cloudy dialysate effluent.

The best management is to start a topical antibiotic at the exit site and continue proper exit-site care (clean technique, appropriate dressings, meticulous cleansing). Systemic antibiotics are added if the infection is more extensive (cellulitis around the exit, persistent drainage, fever, or if there’s concern the infection may involve the tunnel or has not responded to topical therapy). Prompt treatment aims to prevent progression to tunnel infection or peritonitis.