The Effect of Catheter Revision on Intractable Exit Site Infection in CAPD Patients

Kim, Tae Woo; Do, Jun Young; Lee, Sung Hyun; Bae, Dong Un; Jo, Kyu Hyang; Park, Jong Won; Yoon, Kyung Woo

Abstract

BACKGROUND
Continuous ambulatory peritoneal dialysis (CAPD) is an important method of renal replacement therapy in chronic renal failure, and reduction of dialysis-associated complication is essential to successful peritoneal dialysis. But catheter related infection is a major cause of catheter loss and transferring to hemodialysis. We use an unique catheter revision method for the treatment of intractable exit-site/tunnel infection in CAPD patients. METHODS: We reviewed 322 CAPD patients on the ESI/TI from May 1995 to January 2003 at Yeungnam University Hospital. Forty-four patients had exit-site infection more than one times. Prevalence of exit-site infection, kinds of causative micro- organism and results of catheter revision were analyzed retrospectively. RESULTS: Total follow-up was 5, 834 patient months. ESI occurred on 141 occasions in 44 patients out of 322 patients and cumulative incidence of ESI was 1 per 41.4 patient months. We started empiric antibiotic therapy with oral penicillinase- resistant penicillin and quinolones, thereafter adjusted antibiotics according to the results of culture and sensitivity. The most common organism responsible for ESI was Staphylococcus aureus (MSSA, 34.8%), followed by Pseudomonas aeruginosa (25.5%). Nineteen patients had to be treated with catheter revision to control intractable ESI/TI. With analysis of ten patients who showed relapsed ESI after catheter revision, 5 patients improved with antibiotic therapy and 3 patients improved with additional secondary revision, but remaining 2 patients showed removal of peritoneal catheter to treat combined peritonitis. CONCLUSION: Catheter revision technique can be regarded as an effective alternative method to treat intractable exit site/tunnel infection before removal of catheter in CAPD patients.