Epidemiology of peritoneal dialysis exit site infections: Does sex play a role?

Identifying risk factors that pre-dispose people on peritoneal dialysis (PD) to develop exit site infections (ESIs) may help improve prevention and treatment. Given the differences anatomically, hormonally and of the microbiota profile between males and females, we hypothesised that there is a difference in ESI incidence, outcomes, and the epidemiology of organism-specific ESI between males and females. This study was a retrospective case note review of all PD patients at our centre between 2012 and 2024. Of the 486 patients on PD, 202 (42%) were female and 273 positive swabs from 151 patients were identified (0.18 patient episodes/year). We found no statistically significant difference in the incidence of ESI between sexes in our cohort. Gram-positive organisms accounted for 126/273 (46.2%) of all ESI swabs, suggesting that current empiric antibiotic therapy potentially offers effective treatment for less than half of ESI only. We found significant morbidity from ESI: 39 (14%) patients developed peritonitis and 40 (15%) required catheter removal. Sex had no influence on ESI incidence, microbiology of infection or outcome.