Outpatient CAPD catheter salvage for persistent exit-site/tunnel infection

Clouâtre, Yves; Cartier, P; Charbonneau, Robert; Déziel, Clement; Allard, M.; Madore, François

doi:10.1093/ndt/15.2.231

Cited by 22 publications

(28 citation statements)

References 7 publications

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“…However, efforts have been made by some clinicians to retain the catheter (Table 4). 4,10,[18][19][20][21][22][23][24][25][26][27][28] Several treatment modes could be applied prior to catheter removal due to refractory ESI and TI. 13,14 First, deroofing of the tunnel or exteriorization of the external cuff might be performed.…”

Section: Discussionmentioning

confidence: 99%

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Cho

Park

et al. 2012

Nephrology

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: Aim: Catheter‐related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal. Methods: We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed. Results: The total PD duration of all patients was 32 581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient‐months (0.12/patient‐year). The most common causative organism was methicillin‐sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin‐resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S. aureus (6/21, 28.6%). Conclusion: Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.

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Section: Discussionmentioning

confidence: 99%

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Cho

Park

et al. 2012

Nephrology

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“…Alternatively, the catheter can be removed, 38,39 although some authors advocate partial reimplantation of the catheter, with removal of the infected portion and connection of the remaining section to a new, divided catheter. 40 For Gram-negative organisms, ciprofloxacin can be used but in our centre peri-catheter gentamycin is preferred. Persistent Gram-negative infections may require catheter removal as persistent infection is almost always due to a deep tunnel infection, with a risk of peritonitis.…”

Section: Exit Site and Tunnel Infectionsmentioning

confidence: 99%

The surgical management of peritoneal dialysis catheters

Brook

White²,

Waller³

et al. 2004

Ann R Coll Surg Engl

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“…Our PCR technique is similar to that described in previous reports (10,11). Most of the time, the new exit site was made on the opposite side of the abdomen.…”

Section: Methodsmentioning

confidence: 76%