Authors (including presenting author) :
Lam MK (1), Kwan PY (1), Kung Y (1), Chan PW (1), Yip SY (1), Yap YH (1), Choy BY (1), Chan TM (1).
Affiliation :
(1) Nephrology, Department of Medicine, Queen Mary Hospital
Introduction :
There was an outbreak of Burkholderia Cepacia (BC) complex exit site infection (ESI) among peritoneal dialysis (PD) patients due to contamination of 0.05% Aqueous Chlorhexidine by BC complex. We performed BC complex surveillance for the tenckhoff exit sites of all PD patients. 2.5% acetic acid has previously been shown to be effective in treating pseudomonas aeruginosa ESI.
Objectives :
In view of the similar phenotypic properties between pseudomonas and burkholderia species; we perform a study to test for the effectiveness of 2.5% acetic acid as wound dressing for treatment of BC complex ESI.
Methodology :
Exit site swabs were taken from all patients to screen for BC complex. 0.05% Aqueous Chlorhexidine was discontinued and replaced by 0.9% Normal Saline. Patients with positive BC culture were started on 2.5% acetic acid dressing (created by mixing 20ml of HEINZ distilled vinegar containing 5% acetic acid, with sterile water for injection in a 1:1 ratio) to their exit sites, with swabs repeated on day 0. In this 12-week study, patients were reviewed, with swabs being repeated weekly. Antibiotics was added if there was evidence of worsening of ESI.
Result & Outcome :
Two-hundred-and thirty-two patients were screened for BC complex. Sixty-six patients’ exit sites grew BC complex and 55 were recruited into the study. Forty had BC complex colonization while 15 had evidence of ESI. 11/40 in the colonization group cleared their BC complex with switching to NS dressing, In the group with evidence of ESI, 13 had a positive BC complex culture result at day 0 of vinegar dressing. During the 12-week course, 14/29 patients in the colonization group and 5/13 in the infection group successfully cleared the BC complex. Treatment was successful with vinegar dressing alone in 15, while 4 more cleared the bacteria with addition of antibiotics. 23/42 patients were unable to clear the BC complex. Nine patients with initial BC colonization developed evidence of BC complex ESI. Twenty-eight patients developed ESI due to non-BC complex organisms.
