Risk Factors of Catheter Loss Following Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

PURPOSE: Peritoneal dialysis (PD) catheter removal is regarded as an important index of patient morbidity. The aim of this study was to evaluate factors influencing catheter loss following peritonitis in PD patients. METHODS: We retrospectively reviewed 917 episodes of peritonitis in 621 new CAPD patients from Jan 2001 to Feb. 2009 in Dongsan Medical center. Episodes requiring PD catheter removal were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. RESULTS: When peritonitis episodes requiring PD catheter removal (n=80) were compared to catheter preserved peritonitis episodes (n=837), the incidence of PD catheter loss increased as the duration on PD preceding the peritonitis were longer (p<0.000). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level (p=0.009) and high serum CRP level (p<0.000), those with long duration of PD effluent leukocyte count remaining above 100/mm3 (p<0.000), those with concomitant exit site/tunnel infection (p=0.043), and those with presence of abdominal pathology (p<0.000). The microbiological determinants of PD catheter loss included two or more bacteria cultured (p=0.002) and fungi (p<0.000). In multivariate analysis, the duration of PD effluent leukocyte count remaining above 100/mL and the number of organism cultured were independent risk factors of PD catheter removal in peritonitis episodes. CONCLUSION: Duration of PD effluent leukocyte count remaining above 100/mm3, and the number of organisms cultured were independent risk factors for catheter removal following peritonitis.

Risk Factors for Surgical Site Infection among Patients in a General Hospital / 병원감염관리

BACKGROUND: Despite prophylactic preoperative managements, surgical site infection (SSI) still has a significant influence on the mortality and morbidity of surgical patients because of an increased number of immunocompromised patients, prolonged anesthesia or an increased use of various operative equipments. In the end, it leads to an increase in hospital days and medical expenses. Therefore, we tried to find out significant risk factors for SSI in a general hospital. METHODS: The study was carried out on the 1,239 patients who underwent a surgical operation in a general hospital, and the incidence rate and risk factors of SSI were analyzed. RESULTS: Among the 1,239 patients, 33 (2.7%) had SSI and the incidence rate was 26.6 per 1,000 person. Of these, 27 (81.8%) and 6 (18.2%) developed an infection before and after discharge, respectively. The influencing factors of SSI were the dirty wound, the frequency of re-operation, the duration of preoperative hospitalization, and the duration of the operation. The most common pathogen isolated from the surgical site was Staphylococcus aureus (27.2%). CONCLUSION: To prevent SSI, a professional group must be established to manage surgical sites and wounds, and the patients should be covered by strict standardized knowledge and guidance.