Simultaneous replacement and removal of the peritoneal catheter is effective in patients with refractory tunnel infections sustained by S. aureus

Scalamogna, Antonio; Nardelli, Luca; Zubidat, Dalia; Castellano, Giuseppe

doi:10.1007/s11255-022-03288-0

Cited by 11 publications

(18 citation statements)

References 27 publications

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“…6). In the absence of active secondary peritonitis, simultaneous removal and insertion of a new PD catheter should be pursued if the expertise of the center allows to perform the procedure safely [33,[41][42][43] (Fig. 6).…”

Section: Discussionmentioning

confidence: 99%

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

2023

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Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately one third of technical failures are still caused by peritonitis. Recent studies support the theory that ascribes to exit-site and tunnel infections a direct role in causing peritonitis. Hence, prompt exit site infection/tunnel infection diagnosis would allow the timely start of the most appropriate treatment, thereby decreasing the potential complications and enhancing technique survival. Ultrasound examination is a simple, rapid, non-invasive and widely available procedure for tunnel evaluation in PD catheter-related infections. In case of an exit site infection, ultrasound examination has greater sensitivity in diagnosing simultaneous tunnel infection compared to the physical exam alone. This allows distinguishing the exit site infection, which will likely respond to antibiotic therapy, from infections that are likely to be refractory to medical therapy. In case of a tunnel infection, the ultrasound allows localizing the catheter portion involved in the infectious process, thus providing significant prognostic information. In addition, ultrasound performed after two weeks of antibiotic administration allows monitoring patient response to therapy. However, there is no evidence of the usefulness of ultrasound examination as a screening tool for the early diagnosis of tunnel infections in asymptomatic PD patients.

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Section: Discussionmentioning

confidence: 99%

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

2023

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“…112,115 Effectiveness of simultaneous catheter removal and reinsertion was more likely in S. aureus tunnel infection (including cases of simultaneous peritonitis which showed improvement including effluent white cell count). 115 Treatment success, however, was only 50% in relapsing P. aeruginosa peritonitis and tunnel infection. 115 The option of simultaneous catheter removal and reinsertion for resistant organisms including NTM can also be considered, but data for the clinical outcomes remain limited.…”

Section: Surgical Interventions For Catheter-related Infectionmentioning

confidence: 99%

“…115 Treatment success, however, was only 50% in relapsing P. aeruginosa peritonitis and tunnel infection. 115 The option of simultaneous catheter removal and reinsertion for resistant organisms including NTM can also be considered, but data for the clinical outcomes remain limited. 112,116 However, M. abscessus infection should be managed by catheter removal given the high failure rate of simultaneous catheter replacement.…”

Section: Surgical Interventions For Catheter-related Infectionmentioning

confidence: 99%

“…115 Treatment success, however, was only 50% in relapsing P. aeruginosa peritonitis and tunnel infection. 115…”

Section: Management Of Catheter-related Infectionsmentioning

confidence: 99%

“…130 Table 3 summarises the reported outcomes of different surgical interventions. 110,112,114,115,125 –138,140,141…”

Section: Management Of Catheter-related Infectionsmentioning

confidence: 99%

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ISPD Catheter-related Infection Recommendations: 2023 Update

Chow

Cho

et al. 2023

Perit Dial Int

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Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.

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Tunnel ultrasound can guide the use of peritoneal dialysis catheter exit site relocation by external splicing and cuff removal in refractory tunnel infection

Nardelli,

Scalamogna,

Tripodi

et al. 2024

Int Urol Nephrol

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Background Peritoneal dialysis (PD) catheter related infections continue to be a major cause of morbidity and transfer to hemodialysis (HD) in PD patients. The treatment of tunnel infection (TI) could be challenging, especially when the infection involves the superficial cuff requiring the removal of the catheter. To spare the patient the loss of the catheter and the transfer to HD, several mini-invasive surgical techniques have been proposed as rescue therapy. Furthermore, nowadays, the rapid growth of digital technology has enormously increased the diagnostic sensibility of the echo signal allowing to accurately defines the extent of the infectious process along the PD catheter tunnel. Methods Between 1st January 2020 and 31st December 2021 seven patients who underwent exit-site relocation by external splicing and cuff removal at our institution due to refractory TI were included in the study. All patients were followed until 12 months after the procedure. As soon as TI was defined refractory to the medical therapy, an ultrasonographic examination of the catheter tunnel was performed to define the extent of the infectious episode. Results Among the 7 infectious episodes, 4 were caused by P. aeruginosa, and 3 by S. aureus. Around the superficial cuff the hypo/anechoic collections detected by ultrasounds showed a mean diameter of 3.05 ± 0.79 mm. The exit-site relocation by external splicing and cuff removal was successful in all cases (7/7, 100%). Conclusions In our experience the use of exit site relocation by external splicing and cuff removal as rescue therapy for TI with positive ultrasounds for TI limited to superficial cuff involvement and without secondary peritonitis, yielded to promising results with a success rate of 100%. This preliminary experience underlines the paramount usefulness of tunnel echography in accurately defining the extent of TI and, consequently, guiding the choice of the therapeutical approach in refractory TI.

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Simultaneous replacement and removal of the peritoneal catheter is effective in patients with refractory tunnel infections sustained by S. aureus

Cited by 11 publications

References 27 publications

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

ISPD Catheter-related Infection Recommendations: 2023 Update

Tunnel ultrasound can guide the use of peritoneal dialysis catheter exit site relocation by external splicing and cuff removal in refractory tunnel infection

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