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Conservative surgical management of catheter infections in children on peritoneal dialysis

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Abstract

Introduction

Major indications for peritoneal dialysis catheter removal include chronic exit-site infection (ESI) or tunnel infection (TI). No consensus on the optimal treatment of these infections in children exists.

Patients

During the last 10 years, 13 patients (7 females, mean age 56 months) on peritoneal dialysis were treated for recurrent ESI (N: 4) or TI (N: 9). Staphylococcus aureus (12 patients) and Pseudomonas aeruginosa (1 patient) were isolated. All patients had a double-cuff straight Tenchkoff catheter and underwent the shaving of the external cuff, with a new tunnel tightly adherent to the catheter, and an exit-site in the opposite abdominal region. A mean follow-up of 31 months/catheter demonstrated no recurrence of ESI and TI.

Discussion

Little pediatric experience with cuff shaving exists: reported catheter salvage rates are 48–100%. In our experience, good results were obtained by shaving off the external cuff and re-creating a new tunnel, with a different course, strictly adherent to the catheter. This measure seems to guarantee an effective barrier against infections, while obviating the need of the external cuff.

Conclusions

Sometimes, in case of recurrent ESI or TI, the external cuff may facilitate the persistence of bacteria. A conservative surgical treatment offers good results in children.

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References

  1. Burkart JM (1996) Significance, epidemiology, and prevention of peritoneal dialysis catheter infections. Perit Dial Int 16(Suppl 1):S340–S346

    PubMed  Google Scholar 

  2. Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, Piraino B (2005) Randomized, double-blind trial of antibiotic exit-site cream for prevention of exit-site infection in peritoneal dialysis patients. J Am Soc Nephrol 16(2):539–545

    Article  PubMed  CAS  Google Scholar 

  3. Mc Chiu, Tong PC, Lai WM, Lau SC (2008) Peritonitis and exit-site infections in pediatric automated peritoneal dialysis. Perit Dial Int 28(3):S179–S182

    Google Scholar 

  4. Goldraich I, Mariano M, Rosito N, Goldraich N (1993) One-step peritoneal catheter replacement in children. Adv Perit Dial 9:325–328

    PubMed  CAS  Google Scholar 

  5. Chao SH, Tsai TJ (1996) Partial replantation of Tenckhoff catheters to treat intractable exit-site/tunnel infection. J Am Soc Nephrol 7(7):1085–1087

    PubMed  CAS  Google Scholar 

  6. Wu YM, Tsai MK, Chao SH, Tsai TJ, Chang KJ, Lee PH (1999) Surgical management of refractory exit-site/tunnel infection of Tenckhoff catheter: technical innovations of partial replantation. Perit Dial Int 19(5):451–454

    PubMed  CAS  Google Scholar 

  7. Khanna R, Twardowski ZJ (1996) Recommendations for treatment of exit-site pathology. Perit Dial Int 16(Suppl 3):S100–S104

    PubMed  Google Scholar 

  8. Helfrich GB (1982) Results and expectations of renal transplantation. JAMA 247(23):3187

    Article  PubMed  CAS  Google Scholar 

  9. Gloor HJ, Nichols WK, Sorkin MI, Prowant BF, Kennedy JM, Baker B, Nolph KD (1983) Peritoneal access and related complications in continuous ambulatory peritoneal dialysis. Am J Med 74(4):593–598

    Article  PubMed  CAS  Google Scholar 

  10. Lewis MA, Smith T, Roberts D (1996) Peritonitis, functional catheter loss and the sitting of the Dacron cuff in chronic peritoneal dialysis catheters in children. Eur J Pediatr Surg 6(5):285–287

    Article  PubMed  CAS  Google Scholar 

  11. Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M, Mujais S, Verrina E, International Society for Peritoneal Dialysis (ISPD) Advisory Committee on Peritonitis Management in Pediatric Patients (2000) Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20(6):610–624

    PubMed  CAS  Google Scholar 

  12. Piraino B, Bernardini J, Sorkin M (1986) The influence of peritoneal catheter exit-site infections on peritonitis, tunnel infections, and catheter loss in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 8(6):436–440

    PubMed  CAS  Google Scholar 

  13. Piraino B, Bernardini J, Sorkin M (1989) Catheter infections as a factor in the transfer of continuous ambulatory peritoneal dialysis patients to hemodialysis. Am J Kidney Dis 13(5):365–369

    PubMed  CAS  Google Scholar 

  14. Thodis E, Passadakis P, Lyrantzopooulos N, Panagoutsos S, Vargemezis V, Oreopoulos D (2005) Peritoneal catheters and related infections. Int Urol Nephrol 37(2):379–393

    Article  PubMed  Google Scholar 

  15. Twardowski ZJ, Prowant BF, Nichols WK, Nolph KD, Khanna R (1992) Six-year experience with swan neck catheters. Perit Dial Int 12(4):384–389

    PubMed  CAS  Google Scholar 

  16. Vas SI (1994) Treatment of peritonitis. Perit Dial Int 14(Suppl 3):S49–S55

    PubMed  Google Scholar 

  17. Watson AR (1996) Chronic renal failure in childhood. Br J Hosp Med 55(6):329–331

    PubMed  CAS  Google Scholar 

  18. Warady BA, Hébert D, Sullivan EK, Alexander SR, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents: the 1995 annual report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11(1):49–64

    Article  PubMed  CAS  Google Scholar 

  19. Levy M, Balfe JW, Geary D, Fryer-Keene S, Bannatyne R (1990) Exit-site infection during continuous and cycling peritoneal dialysis in children. Perit Dial Int 10(1):31–35

    PubMed  CAS  Google Scholar 

  20. Neu AM, Kohaut EC, Warady BA (1995) Current approach to peritoneal access in North American children: a report of the Pediatric Peritoneal Dialysis Study Consortium. Adv Perit Dial 11:289–292

    PubMed  CAS  Google Scholar 

  21. Oreopoulos DG, Khanna R, Williams P, Vas SI (1982) Continuous ambulatory peritoneal dialysis: 1981. Nephron 30(4):293–303

    Article  PubMed  CAS  Google Scholar 

  22. Lui SL, Li FK, Lo CY, Lo WK (2000) Simultaneous removal and reinsertion of Tenckhoff catheters for the treatment of refractory exit-site infection. Adv Perit Dial 16:195–197

    PubMed  CAS  Google Scholar 

  23. Majkowski NL, Mendley SR (1997) Simultaneous removal and replacement of infected peritoneal dialysis catheters. Am J Kidney Dis 29(5):706–711

    Article  PubMed  CAS  Google Scholar 

  24. Yoshino A, Honda M, Ikeda M, Tsuchida S, Hataya H, Sakazume S, Tanaka Y, Shishido S, Nakai H (2004) Merit of the cuff-shaving procedure in children with chronic infection. Pediatr Nephrol 19(11):1267–1272

    Article  PubMed  Google Scholar 

  25. Lewis MA, Smith T, Postlethwaite RJ, Webb NJ (1997) A comparison of double-cuffed with single-cuffed Tenckhoff catheters in the prevention of infection in pediatric patients. Adv Perit Dial 13:274–276

    PubMed  CAS  Google Scholar 

  26. Schröder CH, Severijnen RS, de Jong MC, Monnens LA (1993) Chronic tunnel infections in children: removal and replacement of the continuous ambulatory peritoneal dialysis catheter in a single operation. Perit Dial Int 13(3):198–200

    PubMed  Google Scholar 

  27. Holley JL, Bernardini J, Piraino B (1994) Infecting organism in continuos ambulatory peritoneal dialysis patients on the Y-set. Am J Kidney Dis 23:569–573

    PubMed  CAS  Google Scholar 

  28. Piraino B (1996) Exit-site care. Perit Dial Int 16(Suppl 1):336–339

    Google Scholar 

  29. Macchini F, Valadè A, Ardissino G, Testa S, Edefonti A, Torricelli M, Luzzani S (2006) Chronic peritoneal dialysis in children: catheter related complications. a single centre experience. Pediatr Surg Int 22(6):524–528

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via Commenda 10, 20122, Milan, Italy

    Francesco Macchini, Alberto Valadè, Maurizio Torricelli & Ernesto Leva

  2. Department of Pediatric Nephrology and Dialysis, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via Commenda 10, Milan, Italy

    Sara Testa, Gianluigi Ardissino & Alberto Edefonti

Authors
  1. Francesco Macchini
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  2. Sara Testa
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  3. Alberto Valadè
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  4. Maurizio Torricelli
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  5. Ernesto Leva
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  6. Gianluigi Ardissino
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  7. Alberto Edefonti
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Correspondence to Francesco Macchini.

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Macchini, F., Testa, S., Valadè, A. et al. Conservative surgical management of catheter infections in children on peritoneal dialysis. Pediatr Surg Int 25, 703–707 (2009). https://doi.org/10.1007/s00383-009-2412-0

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