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Merit of the cuff-shaving procedure in children with tunnel infection

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Abstract

Catheter replacement and cuff-shaving are performed as a surgical treatment against tunnel infection (TI) in patients on chronic peritoneal dialysis. The efficacy of catheter replacement is well established, but that of cuff-shaving is not. For the purpose of evaluating the efficacy of cuff-shaving, we compared the time interval between each procedure and subsequent TI. In order to perform this comparison, we reviewed data from 32 cuff-shaving procedures and 29 catheter replacement procedures at Tokyo Metropolitan Kiyose Children’s Hospital in the period from 1 March 1991 to 1 May 2001, retrospectively. There was no significant difference in the time interval between each procedure and subsequent TI ( P =0.284). The incidence of recurrence was no more than 12.5% for the cuff-shaving procedures. The incidence of peritonitis due to post-surgery TI with the cuff-shaving procedures was 9.3% and 6.8% with the replacement procedure ( P =0.725). There was no significant variation in time interval to post-cuff-shaving TI according to the reason for the cuff-shaving procedure. In conclusion, cuff-shaving may be worth considering for TI in adequately selected patients.

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References

  1. Honda M (1999) The 1997 report of the Japanese National Registry data on pediatric peritoneal dialysis patients. Perit Dial Int 19 [Suppl 2]:473–478

  2. Honda M (1999) The Japanese experience with CAPD/CCPD in children. In: Fine RN, Alexander SR, Warady BA (eds) CAPD/CCPD in children, 2nd edn. Kluwer Academic Science, Boston, pp 301–348

  3. Verrina E, Honda M, Warady BA, Piraino B (2000) Prevention of peritonitis in children on peritoneal dialysis. Perit Dial Int 20:625–630

    CAS  PubMed  Google Scholar 

  4. 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 8:436–440

    CAS  PubMed  Google Scholar 

  5. Nichols WK, Nolph KD (1983) A technique for managing exit-site and cuff infection in Tenckhoff catheters. Perit Dial Bull 3 [Suppl]:4–5

  6. Laurent MST, Surendranath C, Saad T, Halff G, Esterl R JR (1998) A new salvage procedure for peritoneal dialysis catheters with exit-site infections. Am J Surg 64:1215–1217

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  8. Schröder CH, Severijnen RSVM, Jong MCJW de, Monnens LAH (1993) Chronic tunnel infections in children: removal and replacement of the continuous ambulatory peritoneal dialysis catheter in single operation. Per Dial Int 13:198–200

    Google Scholar 

  9. Scalamogna A, Castelnovo C, De Vecchi A, Ponticelli C (1991) Exit-site and tunnel infections in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 18:674–677

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  11. Herlfrich GB, Winchester JF (1982) Questions and answers: ‘shaving’ of the subcutaneous cuff may cure persisting skin exit infection. However, in attempting this procedure one may damage the permanent catheter. Could you describe the details of this technique? Perit Dial Bull 2:183

    Google Scholar 

  12. Suh H, Wadhwa NK, Cabralda T, Bonanno J, Wasiluk A, Sorrento J (1997) Persistent exit-site/tunnel infection and subcutaneous cuff removal in PD patients. Adv Perit Dial 13:233–236

    CAS  PubMed  Google Scholar 

  13. Piraino B, Bernardi J, Peitzman A, Sorkin M (1987) Failure of peritoneal catheter cuff shaving to eradicate infection. Perit Dial Bull 7:179–182

    Google Scholar 

  14. Holley LJ, Bernardi J, Piaino B (1991) Risk factor for tunnel infections in continuous peritoneal dialysis. Am J Kidney Dis 18:344–348

    CAS  PubMed  Google Scholar 

  15. Abraham G, Savin E, Ayiomamitis A, Izatt S, Vas SI, Mathews RE, Oreopoulos DG (1988) Natural history of exit-site infection (ESI) in patients on continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 8:211–216

    Google Scholar 

  16. Piraino B, Bernardini J, Sorkin M (1987) A five-year study of microbiologic results of exit-site infections and peritonitis in continuous ambulatory peritoneal dialysis. Am J Kidney Dis 10:281–286

    CAS  PubMed  Google Scholar 

  17. Sewell C, Clarridge J, Lacke C (1982) Staphylococcal nasal carriage and subsequent infections in peritoneal dialysis patients. JAMA 248:1493–1495

    Article  CAS  PubMed  Google Scholar 

  18. Lerner GR, Warady BA, Sullivan EK, Alexander SR (1999) Chronic dialysis in children and adolescents. Pediatr Nephrol 13:404–417

    Article  CAS  PubMed  Google Scholar 

  19. Warady BA, Sullivan EK, Alexander SR (1996) Lessons from the peritoneal dialysis patient database: a report of the North American Pediatric Renal Transplant Cooperative Study. Kidney Int 49 [Suppl 53]:S68–S71

    Google Scholar 

  20. The Mupirocin Study Group (1996) Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. J Am Soc Nephrol 7:2403–2408

    PubMed  Google Scholar 

  21. Kingwatanakul P, Warady BA (1997) Staphylococcus aureus nasal carriage in children receiving long-term peritoneal dialysis. Adv Perit Dial 13:281–284

    CAS  PubMed  Google Scholar 

  22. Mylotte JM, Kahler L, Jackson E (1999) “Pulse” nasal mupirocin maintenance regimen in patients undergoing continuous ambulatory peritoneal dialysis. Infect Control Hosp Epidermol 20:741–745

    CAS  Google Scholar 

  23. Verrina E, Honda M, Warady BA, Piraino B (2000) Prevention of peritonitis in children on peritoneal dialysis. Perit Dial Int 20:625–630

    CAS  PubMed  Google Scholar 

  24. Crabtree JH, Hadnott LL, Burchette RJ, Siddiqi RA (2000) Outcome and clinical implications of surveillance and treatment program for Staphylococcus aureus nasal carriage in peritoneal dialysis patients. Adv Perit Dial 16:271–275

    CAS  PubMed  Google Scholar 

  25. Araki Y, Hataya H, Ikeda M, Ishikura K, Honda M (2003) Intranasal mupirocin does not prevent exit-site infections in children receiving peritoneal dialysis. Perit Dial Int 23:267–269

    CAS  PubMed  Google Scholar 

  26. Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M (2000) Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20:610–624

    CAS  PubMed  Google Scholar 

  27. Piraino B (2004) New insights on preventing and managing peritonitis. 19:125–127

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Acknowledgements

We thank Professor T. Nagai and Dr. K. Obata from the Department of Pediatrics, Dokkyo University School of Medicine, Koshigaya Hospital, for their kind review of the manuscript and helpful advice.

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Authors and Affiliations

  1. Department of Pediatrics, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama, Japan

    Atsunori Yoshino

  2. Department of Urology, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama, Japan

    Hideo Nakai

  3. Department of Nephrology, Tokyo Metropolitan Kiyose Children’s Hospital, Tokyo, Japan

    Atsunori Yoshino, Masataka Honda, Masahiro Ikeda, Satoko Tsuchida, Hiroshi Hataya, Satoru Sakazume & Yuriko Tanaka

  4. Department of Urology, Tokyo Metropolitan Kiyose Children’s Hospital, Tokyo, Japan

    Seiichiro Shishido

  5. Department of Pediatrics, Dokkyo University, School of Medicine, Koshigaya Hospital, 2–1-50 Minamikoshigaya, Saitama 343–8555, Koshigaya, Japan

    Atsunori Yoshino

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  1. Atsunori Yoshino
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  2. Masataka Honda
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  3. Masahiro Ikeda
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  4. Satoko Tsuchida
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  5. Hiroshi Hataya
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  6. Satoru Sakazume
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  7. Yuriko Tanaka
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  8. Seiichiro Shishido
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  9. Hideo Nakai
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Correspondence to Atsunori Yoshino.

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Yoshino, A., Honda, M., Ikeda, M. et al. Merit of the cuff-shaving procedure in children with tunnel infection. Pediatr Nephrol 19, 1267–1272 (2004). https://doi.org/10.1007/s00467-004-1621-y

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  • DOI: https://doi.org/10.1007/s00467-004-1621-y

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