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

• Published in: Nephrology (Carlton, Vic.) Vic.), 2012-11, Vol.17 (8), p.760-766
• Main Authors: CHO, KYU-HYANG, DO, JUN-YOUNG, PARK, JONG-WON, YOON, KYUNG-WOO
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; catheter revision; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheter-Related Infections - therapy; Catheters, Indwelling - adverse effects; Chi-Square Distribution; continuous ambulatory peritoneal dialysis; Device Removal; end-stage kidney disease; exit site infection; Female; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory - adverse effects; Peritoneal Dialysis, Continuous Ambulatory - instrumentation; Peritonitis - epidemiology; Peritonitis - microbiology; Peritonitis - therapy; Recurrence; Republic of Korea; Retrospective Studies; Time Factors; Treatment Outcome; tunnel infection
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/j.1440-1797.2012.01644.x

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. This paper details how PD catheter revision may be an alternative option to catheter removal for refractory exit site infections and tunnel infections. This involves the removal of the external cuff and infected tissue above the internal cuff and creation of a new subcutaneous tunnel and exit‐site under local anaesthetic. There were 36 catheter revisions performed and the outcomes are presented in addition to details of this group's PD exit site infection rate, organisms involved and ou