Exposure to Shower Water Without Dressings Is Associated With Increased Risk of Catheter-Related Infection in Peritoneal Dialysis Patients: A Retrospective Cohort Study.

Abstract

Introduction: Preventing catheter-related infection (CRI) and peritonitis remains a challenge in peritoneal dialysis (PD). This study assessed whether showering without covering the catheter exit site increases CRI risk.

Methods: This single-center retrospective cohort study was conducted between January 2019 and December 2022, and included all patients who were receiving PD at the beginning of the study or initiated PD during the study period. Participants were classified into two groups: those who covered the exit site with waterproof dressings during showering (dressing group), and those who took showers with the exit site uncovered (uncovered group). The primary outcome was CRI-free catheter survival; the secondary outcome was catheter-related peritonitis.

Results: Of 188 eligible patients, 42 were excluded. Among the remaining 146, 54 were in the dressing group and 92 in the uncovered group. The mean age was 70.4 ± 11.1 years and 63.3 ± 12.9 years, respectively; 59% and 72% were male. CRI occurred in 29 patients in the dressing group and 76 patients in the uncovered group. The uncovered group had a significantly higher risk of CRI by the log-rank test (p < 0.01). In a multivariate Cox proportional-hazards model adjusted for potential confounders, uncovered showering remained an independent predictor of CRI (hazard ratio 2.29; 95% confidence interval 1.40-3.76; p < 0.01), along with a history of prior CRI. No cases of catheter-related peritonitis occurred in either group.

Conclusion: Showering without covering the exit site is associated with an increased risk of CRI in PD patients.