Failure of Peritoneal Catheter CUFF Shaving to Eradicate Infection

1987 ◽  
Vol 7 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Beth Piraino Judy ◽  
Bernardini Andrew Peitzman ◽  
Michael Sorkin
Keyword(s):  
Antibiotic Therapy ◽  
Survival Time ◽  
Alternative Methods ◽  
Catheter Removal ◽  
Site Infection ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Infection

Often the catheter is lost when exitsite infections fail to resolve with antibiotic therapy. Excision of the external cuff has been proposed as an alternative to catheter removal. Prospectively we recorded the results of 22 cuff-shaving procedures and all subsequent CAPD-related infections. After the cuff shaving we encountered six dialysate leaks, which resulted in catheter removal. In 10 other patients, four developed peritonitis, four tunnel infection and two recurrent exit..site infection with the same micro-organism that caused the original exit site infection. Cuff shaving did not decrease the exit-site infection and peritonitis rates. Median catheter survival time after the cuff shaving was 1.5 months (range from 0 to 23 months). In conclusion, cuff shaving often fails to eradicate catheter infection. We need to develop alternative methods for treating and preventing exit-site infections.

Lower Malfunction Rate with Self-Locating Catheters

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 209-212 ◽  
Author(s):  
Ignacio Minguela ◽  
Manuel Lanuza ◽  
Ramón Ruiz De Gauna ◽  
Raquél Rodado ◽  
Soledad Alegría ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
T Test ◽  
Catheter Removal ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Kaplan Meier

Objective We analyzed malfunction rates (obstruction, omental wrapping, displacement) and catheter survival for self-locating catheters as compared with other Tenckhoff catheter designs. Patients and Methods We conducted our survey at two centers, prospectively studying all self-locating catheters implanted from May 1997 to October 2000 and used for peritoneal dialysis (PD). Tenckhoff catheters of other designs used previously in our units were used as the control group. We analyzed removal causes and catheter survival. Results We studied 173 catheters (105 self-locating catheters, 53 straight catheters, and 15 coiled catheters) implanted in 139 patients (43% of them women) with a mean age of 53 ± 14 years. The analysis of catheter removal showed that 3 of 105 self-locating catheters, 3 of 15 coiled catheters, and 17 of 53 straight catheters were removed owing to malfunction (c 2: p = 0.0000). Kaplan–Meier curves showed that the bulk of removals for malfunction occurred within the first 3 months after PD start. The group of self-locating catheters showed better survival (log-rank: p = 0.0009). Other causes for catheter removal included peritonitis ( n = 22), exit-site infection alone ( n = 4), and end of PD treatment ( n = 66). No significant differences were seen in the annual peritonitis rate (straight-tip: 0.955 ± 2.315 episodes annually; coiled-tip: 0.651 ± 0.864 episodes annually; self-locating: 0.720 ± 1.417 episodes annually; t-test: p > 0.400). No gut or bladder perforations were observed. Conclusion In our survey, self-locating catheters were associated with better survival and fewer removals for malfunction than were Tenckhoff catheters of other designs.

The Efficacy of Silver-Ion Implanted Catheters in Reducing Peritoneal Dialysis-Related Infections

2003 ◽  
Vol 23 (4) ◽  
pp. 368-374 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette ◽  
Rukhsana A. Siddiqi ◽  
Isan T. Huen ◽  
Linda L Hadnott ◽  
...  
Keyword(s):  
Ion Beam ◽  
Controlled Trial ◽  
Silver Ion ◽  
Control Group ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
And Control

♦ Background Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. ♦ Objective The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. ♦ Methods The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. ♦ Results The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis ( p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis ( p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections ( p = 0.58), peritonitis ( p = 0.44), or both infections combined ( p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection ( p> 0.2) or peritonitis ( p > 0.7). Similarly, catheter survival was not significantly different between the groups ( p > 0.6). ♦ Conclusion Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

Exit-Site Infection in Continuous Ambulatory Peritoneal Dialysis: A Review

1991 ◽  
Vol 11 (4) ◽  
pp. 333-340 ◽  
Author(s):  
Mary Anne Luzar
Keyword(s):  
Healing Process ◽  
Nasal Carriage ◽  
Epidemiological Studies ◽  
Future Research ◽  
Site Infection ◽  
Exit Site ◽  
Term Care ◽  
Exit Site Infection ◽  
Nasal Carrier ◽  
Catheter Survival

Although the ability of CAPD to successfully treat end-stage renal disease is now well established, exitsite infection (ESI) remains a serious cause of morbidity. The objective of this article is to review recent advancements relating to ESI pathogenesis and its reduction. Current definitions of ESI are reviewed, as are comparative studies of etiology. Emphasis is placed on the literature identifying Staphylococcus aureus as the primary cause of ESI in CAPD. The article reviews reported rates of ESI and discusses reasons for variations of this complication's reported frequency. The selection of catheters available in CAPD are discussed, as are studies demonstrating the threat of S. aureus to catheter survival. The pathogenesis of exit-site infection related to S. aureus nasal carriage in CAPD is reviewed in light of recent findings indicating the pre-CAPD nasal carrier as the patient at risk for subsequent ESI. Postoperative and long-term care of the catheter patient are reviewed for various literature protocols. Treatment recommendations for choice of agents are discussed. Future research should include a better understanding of the morphology of the CAPD catheter exit-site in humans and the healing process. ESI epidemiological studies should be encouraged in tandem with well -designed, controlled studies on the value of prophylactic treatment.

Experience with the Toronto Western Hospital Permanent Peritoneal Catheter

1984 ◽  
Vol 4 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Ramesh Khanna ◽  
Sharron Izatt ◽  
Debby Burke ◽  
Raymond Mathews ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Toronto Western Hospital ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Western Hospital ◽  
Catheter Tip ◽  
Catheter Failure

Prospective controlled trial with Tenckhoff, Toronto Western Hospital and Goldberg catheter showed a lower incidence of catheter-tip dislodgement from the pelvis with the Toronto Western Hospital catheter. A 1982 retrospective review of experiences, revealed significantly better one and two year catheter survival with the Toronto Western Hospital catheter #2 compared to the straight Tenckhoff catheter inserted at the bed side but not compared to the surgically inserted Tenckhoff catheter. Early dialysate leak was a significant compilation observed with the use of all catheters. Lateral placement of catheters has practically eliminated this complication. Catheter exit site infection now is the major cause of catheter failure.

scholarly journals MP503UNROOFING SURGERY FOR PERITONEAL CATHETER EXIT SITE INFECTION WITH EXTERNAL CUFF INVOLVEMENT

2016 ◽  
Vol 31 (suppl_1) ◽  
pp. i507-i508
Author(s):  
Milos Mitrovic ◽  
Miroslava Popovic ◽  
Tatjana Damjanovic ◽  
Zdenka Majster ◽  
ALeksandar Jankovic ◽  
...  
Keyword(s):  
Site Infection ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Exit Site Infection

scholarly journals Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home

2015 ◽  
Vol 23 (5) ◽  
pp. 902-909 ◽  
Author(s):  
Ana Cristina Freire Abud ◽  
Luciana Kusumota ◽  
Manoel Antônio dos Santos ◽  
Flávia Fernanda Luchetti Rodrigues ◽  
Marta Maria Coelho Damasceno ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Cross Sectional ◽  
Exit Site Infection ◽  
Length Of Treatment ◽  
At Home

Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance.Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015).Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment.

scholarly journals Pseudomonas exit site infections in continuous ambulatory peritoneal dialysis patients.

1992 ◽  
Vol 2 (10) ◽  
pp. 1498-1501
Author(s):  
H R Kazmi ◽  
F D Raffone ◽  
A S Kliger ◽  
F O Finkelstein
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Catheter Removal ◽  
Site Infection ◽  
Dialysis Patients ◽  
Exit Site ◽  
Exit Site Infection ◽  
Retrospective View ◽  
History Of ◽  
Oral Ciprofloxacin

The purpose of this study is to examine the natural history of Pseudomonas aeruginosa exit site infections in continuous ambulatory peritoneal dialysis (CAPD) patients treated with oral ciprofloxacin and local exit site care. A retrospective view was undertaken of 18 episodes of P. aeruginosa exit site infections developing in 17 patients maintained on CAPD during 1989 and 1990. Standardized therapy for the exit site infection consisted of oral ciprofloxacin (500 mg twice daily) and local exit site care with antiseptic agents. Fifteen (83%) of 18 of the pseudomonas exit site infections resolved with therapy. Three episodes (17%) required catheter removal to successfully eradicate the infection. Four of the 15 patients whose exit site infections resolved developed P. aeruginosa peritonitis 2 to 9 months after the clinical resolution of the exit site infection. The majority of pseudomonas exit site infections in CAPD patients can be successfully treated with oral ciprofloxacin and local care. Approximately 17% of the patients in this study required catheter removal to successfully eradicate the infection and an additional 22% of the patients developed pseudomonas peritonitis several months after the resolution of the exit site infection.

Clinical course of peritoneal dialysis-related peritonitis due to non-tuberculosis mycobacterium – A single centre experience spanning 20 years

2021 ◽  
pp. 089686082110424
Author(s):  
Winston Wing-Shing Fung ◽  
Kai-Ming Chow ◽  
Philip Kam-Tao Li ◽  
Cheuk-Chun Szeto
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Course ◽  
Primary Response ◽  
Catheter Removal ◽  
Mycobacterium Fortuitum ◽  
Site Infection ◽  
Exit Site ◽  
Mycobacterium Chelonae ◽  
Exit Site Infection ◽  
Delay In Diagnosis

Background: Peritoneal dialysis (PD)-related peritonitis caused by non-tuberculous mycobacteria (NTM) are difficult to diagnose, is associated with significant morbidity and mortality, and clinical course remains unclear. We determined the prevalence and clinical course of peritonitis caused by these organisms through our kidney registry over 20-year period. Method: We reviewed all patients with NTM peritonitis identified in our tertiary centre between July 2000 and July 2020. The demographic characteristics, microbiological and clinical outcomes were examined. Result: Among 27 patients identified, 20 patients presented with abdominal pain and all had cloudy peritoneal fluid. Twenty-one cases had concomitant exit site infection and 14 cases had prior antibiotic use. The majority of the cases are caused by Mycobacterium chelonae (37%) and Mycobacterium fortuitum (29.7%), with most being resistant to fluoroquinolones (59.3%) and cefoxitin (73.1%). They are all sensitive to amikacin otherwise. None of the cases achieve primary response at day 10 and 20 cases resulted in Tenckhoff catheter removal. Only two of them were able to resume PD. Eight patients died in our cohort. The presence of exit site infection, the use of prior antibiotics and topical disinfectants did not associate with a poorer outcome. Conclusion: NTM peritonitis remains difficult to treat and often with a delay in diagnosis. Refractory peritonitis with negative culture and a poor response to standard antibiotics should raise a possibility of NTM infection and prompt catheter removal and an expert with experience treating NTM infections should be consulted.

Comparison of Topical Chlorhexidine and Mupirocin for the Prevention of Exit-Site Infection in Incident Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (3) ◽  
pp. 266-272 ◽  
Author(s):  
Htay Htay ◽  
David W. Johnson ◽  
Sin Yan Wu ◽  
Elizabeth Ley Oei ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Hospitalization Rate ◽  
Catheter Removal ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Singapore General Hospital

Objective Prevention of exit-site infection (ESI) is of paramount importance to peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effectiveness of chlorhexidine in the prevention of ESI in incident PD patients compared with mupirocin. Methods This retrospective, pre-test/post-test observational study included all incident PD patients at Singapore General Hospital from 2012 to 2015. Patients received daily topical exit-site application of either mupirocin (2012 – 2013) or chlorhexidine (2014 – 2015) in addition to routine exit-site cleaning with 10% povidone-iodine. The primary outcome was ESI rate during the 2 time periods. Secondary outcomes were peritonitis rate, times to first ESI and peritonitis, hospitalization rate, and infection-related catheter removal. Event rates were analyzed using Poisson regression, and infection-free survival was estimated using Kaplan-Meier and Cox regression survival analyses. Results The study included 162 patients in the mupirocin period (follow-up 141.5 patient-years) and 175 patients in the chlorhexidine period (follow-up 136.9 patient-years). Compared with mupirocin-treated patients, chlorhexidine-treated patients experienced more frequent ESIs (0.22 vs 0.12 episodes/patient-year, p = 0.048), although this was no longer statistically significant following multivariable analysis (incidence rate ratio [IRR] 1.78, 95% confidence interval [CI] 0.98 – 3.26, p = 0.06). No significant differences were observed between the 2 groups with respect to time to first ESI ( p = 0.10), peritonitis rate ( p = 0.95), time to first peritonitis ( p = 0.60), hospitalization rate ( p = 0.21) or catheter removal rate (0.03 vs 0.04/patient-year, p = 0.56). Conclusions Topical exit-site application of chlorhexidine cream was associated with a borderline significant, higher rate of ESI in incident PD patients compared with mupirocin cream.

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