scholarly journals Management of peritoneal dialysis Mycobacterium abscessus exit-site infection: A case report and literature review

2021 ◽  
pp. 112972982110150
Author(s):  
Korey Bartolomeo ◽  
Mohamed Hassanein ◽  
Tushar J Vachharajani
Keyword(s):  
Peritoneal Dialysis ◽  
Mycobacterium Abscessus ◽  
High Morbidity ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Empiric Antibiotic ◽  
End Stage

Peritoneal dialysis associated infections are common and associated with high morbidity and mortality, if not treated in a timely manner. Mycobacterium abscessus is an uncommon pathogen in peritoneal dialysis associated infections, but is resistant to standard antimicrobial therapies used. Here we present a case of a 56 year-old male with end stage kidney disease on peritoneal dialysis for 7 years who developed a Mycobacterium abscessus exit-site infection. Peritonitis and peritoneal dialysis catheter tunneled line infections were ruled out and he was treated with linezolid, amikacin, and azithromycin. He required peritoneal dialysis catheter removal and hemodialysis conversion. Antibiotics were de-escalated based on erm inducibility and antibiotic sensitivities. Linezolid and amikacin were continued for approximately 7 total weeks, with complete resolution of the infection. Further research is needed to refine challenges in the management of Mycobacterium abscessus exit-site infections, including risk factors for development of Mycobacterium abscessus, optimal selection of empiric antibiotic therapies, duration of antibiotics, and peritoneal dialysis catheter re-insertion timing.

Treatment of Refractory Pseudomonas Aeruginosa Exit-Site Infection by Simultaneous Removal and Reinsertion of Peritoneal Dialysis Catheter

2005 ◽  
Vol 25 (6) ◽  
pp. 560-563 ◽  
Author(s):  
Sing Leung Lui ◽  
Terence Yip ◽  
Kai Chung Tse ◽  
Man Fai Lam ◽  
Kar Neng Lai ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Antibiotic Treatment ◽  
Simultaneous Removal ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Optimal Interval

Background Patients on continuous ambulatory peritoneal dialysis (CAPD) with Pseudomonas aeruginosa exit-site infection (ESI) refractory to antibiotic treatment often require replacement of their peritoneal dialysis catheter (PDC). The optimal interval between removal and reinsertion of the PDC is not known. There are relatively few data on the feasibility of simultaneous removal and reinsertion of dialysis catheters for the treatment of P. aeruginosa ESI. Methods We retrospectively reviewed the short- and long-term outcomes of all CAPD patients who had undergone simultaneous removal and reinsertion of their PDC for the treatment of refractory P. aeruginosa ESI in our hospital between January 1994 and December 2003. During the operation, the old catheter was removed first and a new catheter was inserted into the opposite side of the abdomen. All patients received 7 days of antibiotic therapy postoperatively. CAPD was resumed after 2 weeks of intermittent peritoneal dialysis. Results Over a 10-year period, 37 CAPD patients underwent the operation. Mean age of the patients was 59.5 ± 10.9 years. The interval between the diagnosis of ESI and the operation was 16.7 ± 6.9 weeks. The patients received 7.6 ± 2.5 weeks of antibiotic treatment before the procedure. Early postoperative complications were uncommon. None of the patients developed ESI within 4 weeks after the operation. At 1 year after the operation, 3 patients (8%) had developed recurrence of P. aeruginosa ESI 24 – 40 weeks postoperatively. Peritonitis due to P. aeruginosa was not observed. Conclusions We conclude that simultaneous removal and reinsertion of the PDC is feasible in eradicating refractory ESI due to P. aeruginosa. This procedure alleviates the need for temporary hemodialysis and allows continuation of peritoneal dialysis.

scholarly journals Exit-Site Infection and Acute Peritonitis Due to Peritoneal Dialysis Catheter Rupture

2015 ◽  
Vol 35 (3) ◽  
pp. 362-363 ◽  
Author(s):  
Maša Knehtl ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Matjaž Horvat ◽  
Radovan Hojs
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Acute Peritonitis

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 06-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
P Value ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

Outcomes of Peritoneal Dialysis Catheter Left in Place after Kidney Transplantation

2017 ◽  
Vol 37 (6) ◽  
pp. 651-654 ◽  
Author(s):  
Saúl Pampa-Saico ◽  
Fernando Caravaca-Fontán ◽  
Víctor Burguera-Vion ◽  
Víctor Diéz Nicolás ◽  
Estefanía Yerovi-León ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Graft Function ◽  
Optimal Time ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection

No clear consensus has been reached regarding the optimal time to remove the peritoneal dialysis catheter (PDC) after kidney transplantation (KT). This retrospective observational study, conducted in a single peritoneal dialysis (PD) unit including all PD patients who received a KT between 1995 - 2015, was undertaken to evaluate the clinical outcomes and potential complications associated with a PDC left in place after KT. Of the 132 PD patients who received a KT, 20 were excluded from the study. Of the remaining, 112 (85%) patients with functioning KT were discharged with their PDC left in place and had it removed in a mean interval of 5 ± 3 months after KT, after achieving optimal graft function. During this follow-up period, 7 patients (6%) developed exit-site infection and there were 2 cases (2%) of peritonitis; all of them were successfully treated. Delayed PDC removal after KT is associated with low complication rates, although regular examination is needed so that mild infections can be detected early and therapy promptly instituted.

Swan Neck Presternal Peritoneal Dialysis Catheter: Five-Year Experience in Children

1998 ◽  
Vol 18 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Stanislaw Warchol ◽  
Maria Roszkowska-Blaim ◽  
Maria Sieniawska
Keyword(s):  
Peritoneal Dialysis ◽  
Major Complication ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Medical Academy ◽  
Subcutaneous Tunnel ◽  
A Prospective Study ◽  
Observation Period

Objectives To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titanium connector, with the exit site located on the chest wall, was designed. Design A prospective study was undertaken to estimate the usefulness of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children. Setting University Children's Hospital, Medical Academy, Warsaw, Poland. Patients From December 1991 to June 1997, 11 SNPCs were implanted in 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More than one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted. Intervention In all children the presternal catheter was implanted surgically by the modification of the technique described by Twardowski et al. Results The observation period ranged from 1 -60 months. The rate of ESI was 11162 patient-months. The major complication was trauma of the exit site (4 times in 3 of 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two parts of the SNPC became disconnected in 2 children (after 7 and 33 months respectively). Conclusion Our results achieved with the SNPC in children are very good. The presternal catheter reduces the risk of ESI. However, the chest localization of the exit site does not help to prevent trauma in children. This type of PD catheter should be reserved for patients with specific indications.

Prospective Comparison of Downward and Lateral Peritoneal Dialysis Catheter Tunnel-Tract and Exit-Site Directions

2006 ◽  
Vol 26 (6) ◽  
pp. 677-683 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Mechanical Complications ◽  
Tunnel Infection ◽  
Kaplan Meier ◽  
Lateral Tunnel

Objective Guidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations. Methods This prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site. Results Kaplan–Meier survivals were not different for time to first exit-site infection ( p = 0.62), tunnel infection ( p = 0.89), or peritonitis ( p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan–Meier analyses of antibiotic-free intervals for exit-site ( p = 0.94) and peritonitis infections ( p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different ( p = 0.20). Conclusions Catheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.

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