The use of mini-invasive surgical techniques to treat refractory exit-site and tunnel infections in peritoneal dialysis patients: a clinical approach

Scalamogna, Antonio; Nardelli, Luca; Castellano, Giuseppe

doi:10.1007/s40620-022-01479-7

Cited by 6 publications

(6 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As far as catheter-related peritonitis is concerned, in our unit the extensive use of mini-invasive surgical technique in refractory tunnel infections could have prevented the occurrence of secondary peritonitis in some cases 19,20 ; while the employ of simultaneous removal and replacement of peritoneal catheter in peritonitis arising in conjunction with the exit-site or tunnel infections could have decrease the associated HD transfer rate 21 .…”

Section: Discussionmentioning

confidence: 93%

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Nardelli,

Scalamogna,

Ponzano

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. Methods Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. Results The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, HD transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. Conclusions The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

show abstract

Section: Discussionmentioning

confidence: 93%

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Nardelli,

Scalamogna,

Ponzano

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…In this case a surgical approach should be avoided, and antibiotic prolonged for at least another week. At the end of the therapy, it would be useful to repeat On the other hand, if the total accumulation does not decrease by at least 30% after 2 weeks of appropriate antibiotic therapy, proceeding with the removal of the superficial cuff and prolonging antibiotic therapy is recommended if the US does not detect an extension of the infection beyond the superficial cuff [21,39,40]. Conversely, if the infection has spread to the deep cuff or to the portion of the tunnel between the two cuffs, removal of the peritoneal catheter is indicated (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the persistence of ultrasonographic signs attributable to the infectious process would direct the clinician to alternative therapeutic interventions (e.g. mini-surgical revision or catheter removal) [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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

2023

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…14 Other salvage strategies have therefore been proposed. 118 Extrusion of the external cuff through the exit site is a mechanical complication resulting from shape-memory resilience forces induced by bending a catheter in the subcutaneous track that has a straight intercuff tubing segment. 14 Over time, the tubing returns to its native straight configuration with migration of the external cuff towards the exit site.…”

Section: Surgical Interventions For Catheter-related Infectionmentioning

confidence: 99%

ISPD Catheter-related Infection Recommendations: 2023 Update

Chow

Cho

et al. 2023

Perit Dial Int

View full text Add to dashboard Cite

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.

show abstract

The use of mini-invasive surgical techniques to treat refractory exit-site and tunnel infections in peritoneal dialysis patients: a clinical approach

Cited by 6 publications

References 42 publications

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

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

ISPD Catheter-related Infection Recommendations: 2023 Update

Contact Info

Product

Resources

About