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

  • Nephrology - Original Paper
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Abstract

Background

In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) and the creation of a temporary vascular access. However, simultaneous removal and reinsertion of the PD catheter (SCR) represents another possible therapeutic approach.

Methods

We analysed the outcome of 20 patients (10 men and 10 women, mean age 65.5 ± 16.3 years) treated by CAPD for a mean period of 24.3 ± 14.2 months who underwent to SCR for the treatment of TI unresponsive to medical therapy or TI that occurred simultaneously with peritonitis at Fondazione Ca' Granda Ospedale Maggiore Policlinico. All the patients restarted CAPD exchanges within 24 h from catheter placement.

Results

SCR was successful in 80% (16/20) of the cases. In particular, SCR was effective in 100% (11/11) of the TI with or without associated peritonitis sustained by S. aureus. However, SCR failed in 57% (4/7) of TI associated with relapsing peritonitis and in one patient with TI secondary to Enterobacter. No early mechanical complications (within 3 months after SCR) occurred when CAPD was restarted.

Conclusions

SCR of the PD catheter through double-purse string technique represents an effective treatment for TI without or with simultaneously peritonitis sustained by S. aureus avoiding the patient the need for temporary hemodialysis and second surgical procedure. However, SCR could be contraindicated in case of relapsing peritonitis.

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References

  1. Fried L, Bernardini J, Johnston J, Piraino B (1996) Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 7:2176–2182

    Article  CAS  Google Scholar 

  2. Fontan M, Rodriguez-Carmona A, Garcia-Naveiro R, Al E (2005) Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis. Perit Dial Int 25:274–284

    Article  Google Scholar 

  3. Nardelli L, Scalamogna A, Messa P (2021) The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients. J Nephrol 34:493–501

    Article  CAS  Google Scholar 

  4. Costerton JW, Cheng KJ, Geesey GG, Ladd TI, Nickel JC, Dasgupta MMT (1987) Bacterial biofilms in nature and disease. Ann Rev Microbiol 41:435–464

    Article  CAS  Google Scholar 

  5. Dasgupta M, Kowalewska-Grochowska K, Larabie M, Costerton J (1991) Catheter biofilms and recurrent CAPD peritonitis. Adv Perit Dial 7:165–168

    CAS  Google Scholar 

  6. Scalamogna A, Nardelli L, Cosa F et al (2021) Mini-invasive surgical techniques for the peritoneal catheter rescue in refractory tunnel infections. G Ital Nefrol 1:3

    Google Scholar 

  7. Scalamogna A, De VA, Maccario M et al (1995) Cuff-shaving procedure. A rescue treatment for exit-site infection unresponsive to medical therapy. Nephrol Dial Transplant 10:2325–2327

    Article  CAS  Google Scholar 

  8. Muraoka K, Ishibashi Y, Yamaguchi J et al (2011) Early partial re-implantation of Tenckhoff catheters to treat intractable exit-site or tunnel infection. Perit Dial Int 31:350–353

    Article  Google Scholar 

  9. Gupta B, Bernardini J, Piraino B (1996) Peritonitis associated with exit site and tunnel infections. Am J Kidney Dis 28:415–419

    Article  CAS  Google Scholar 

  10. Szeto C, Li PK, Johnson DW et al (2017) ISPD catheter-related infection recommendations: update. Perit Dial Int 37:141–154

    Article  Google Scholar 

  11. Paterson AD, Morgan AG, Bishop MC, Burden RP (1986) Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis. Lancet 4:1245–1247

    Article  Google Scholar 

  12. Grefberg N (1986) Renewal of Tenckhoff catheters. Lancet 27:1467

    Article  Google Scholar 

  13. Morton A, Waldek S, Holmes A (1987) Removal and replacement of Tenckhoff catheters. Lancet 1:229

    Article  CAS  Google Scholar 

  14. Ludlam H, Young A, Wing AJ (1989) Removal and replacement of Tenckhoff catheter at single operation. Lancet 1:1028

    Article  CAS  Google Scholar 

  15. Williams AJ, Johnson BF, Raftery AT et al (1989) Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Perit Dial Int 9:65–67

    Article  CAS  Google Scholar 

  16. Swartz R, Messana J, Reynolds J, Ranjit U (1991) Simultaneous catheter replacement and removal in refractory peritoneal dialysis infections. Kidney Int 40:1160–1165

    Article  CAS  Google Scholar 

  17. Schröder C, Severijnen R, de Jong M, Monnens L (1993) Chronic tunnel infections in children: removal and replacement of the continuous ambulatory peritoneal dialysis catheter in a single operation. Perit Dial Int 13:198–200

    Article  Google Scholar 

  18. Cancarini GC, Manili L, Brunori G et al (1994) Simultaneous catheter replacement-removal during infectious complications in peritoneal dialysis. Adv Perit Dial 10:210–213

    CAS  Google Scholar 

  19. Majkowski NL, Mendley SR (1997) Simultaneous removal and replacement of infected peritoneal dialysis catheters. Am J Kidney Dis 29:706–711

    Article  CAS  Google Scholar 

  20. Posthuma N, Borgstein PJ, Eijsbouts Q, Wee PM (1998) Simultaneous peritoneal dialysis catheter insertion and removal in catheter-related infections without interruption of peritoneal dialysis. Nephrol Dial Transpl 13:700–703

    Article  CAS  Google Scholar 

  21. Lui SL, Yip T, Tse KC et al (2005) Treatment of refractory pseudomonas aeruginosa exit-site infection by simultaneous removal and reinsertion of peritoneal dialysis catheter. Perit Dial Int 25:560–563

    Article  Google Scholar 

  22. Crabtree J, Siddiqi R (2016) Simultaneous catheter replacement for infectious and mechanical complications without interruption of peritoneal dialysis. Perit Dial Int 36:182–187

    Article  CAS  Google Scholar 

  23. Nardelli L, Scalamogna A, Zeiler M, Messa P (2020) Use of ultrasounds in PD catheter related infections: indications and clinical implications. G Ital Nefrol S 75:7

    Google Scholar 

  24. Li PK, Chow KM, Cho Y et al (2022) ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 42:110–153

    Article  Google Scholar 

  25. Scalamogna A, Nardelli L, Zanoni F, Messa P (2020) Double purse-string around the inner cuff of the peritoneal catheter: a novel technique for an immediate initiation of continuous peritoneal dialysis. Int J Artif Organs 43:365–371

    Article  Google Scholar 

  26. Scalamogna A, Nardelli L, Messa P (2020) Double purse-string craft around the inner cuff: a new technique for an immediate initiation of CAPD. G Ital Nefrol 1:7

    Google Scholar 

  27. Piraino B (1998) Peritonitis as a complication of peritoneal dialysis. J Am Soc Nephrol 9:1956–1964

    Article  CAS  Google Scholar 

  28. Szeto C, Chow K, Wong TY et al (2002) Feasibility of resuming peritoneal dialysis after severe peritonitis and Tenckhoff catheter removal. J Am Soc Nephrol 13:1040–1045

    Article  Google Scholar 

  29. Cho Y, Badve SV, Hawley CM et al (2014) Peritoneal dialysis outcomes after temporary haemodialysis transfer for peritonitis. Nephrol Dial Transpl 29:1940–1947

    Article  Google Scholar 

  30. Singhal M, Vas S, Oreopoulos D (2000) Treatment of peritoneal dialysis catheter-related infections by simultaneous catheter removal and replacement. Is it safe? Perit Dial Int 20:412–417

    Google Scholar 

  31. Viron C, Lobbedez T, Lanot A et al (2019) Simultaneous removal and reinsertion of the PD catheter in relapsing peritonitis. Perit Dial Int 39:282–288

    Article  CAS  Google Scholar 

  32. Scalamogna A, Nardelli L, Cicero E, Castellano G (2022) Analysis of mechanical complications in urgent-start peritoneal dialysis. J Nephrol 35:1489–1496

    Article  Google Scholar 

  33. Nardelli L, Scalamogna A, Pisati S, Gallieni M (2021) Urgent-start PD: a viable approach. G Ital Nefrol 2:7

    Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Antonio Scalamogna, Luca Nardelli & Giuseppe Castellano

  2. Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy

    Luca Nardelli & Giuseppe Castellano

  3. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Luca Nardelli & Dalia Zubidat

Authors
  1. Antonio Scalamogna
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  2. Luca Nardelli
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  3. Dalia Zubidat
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  4. Giuseppe Castellano
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Contributions

Research idea and study design: LN and AS; data acquisition: LN; data analysis/interpretation: LN and AS; statistical analysis: LN and DZ; supervision or mentorship: GC. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Luca Nardelli.

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We have read and understood International Urology and Nephrology’s policy on disclosing conflicts of interest and declare that we have none.

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Scalamogna, A., Nardelli, L., Zubidat, D. et al. Simultaneous replacement and removal of the peritoneal catheter is effective in patients with refractory tunnel infections sustained by S. aureus. Int Urol Nephrol 55, 151–155 (2023). https://doi.org/10.1007/s11255-022-03288-0

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  • DOI: https://doi.org/10.1007/s11255-022-03288-0

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