39 YEAR old PD patient with exit site skin RASH

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3 years ago

A 39 -year-old peritoneal dialysis (PD) patient with 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. 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 Scroll below for answer Answer is choice 3 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 antibiotic

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