Background: Unroofi ng is a controversial procedure to avoid catheter removal in the treatment of the chronic exit site and tunnel infection, but is now rarely recommended. Here we aimed to evaluate the effects of the unroofi ng procedure on peritoneal catheter survival. Methods: From our database, we prospectively evaluated the outcome of 139 peritoneal catheters placed in 121 patients (1.14 catheters per patient, 73 female, 48 male) from 08-03-1993 to 12-31-2016. Twenty-three infected catheters needed surgical unroofi ng of the tunnel tract. We calculated the cumulative catheter survival rates (Kaplan-Meier) of 1) overall catheters and 2) not unroofed catheters, considering catheter removal as an endpoint. We also calculated 3) the unroofed catheter survival, considering the date of unroofi ng or catheter removal as the endpoint and, 4) continuity of the unroofed catheters post-unroofi ng, considering the unroofi ng date as if it were a new catheter and catheter removal as the endpoint. Likewise, we compared the survival of: a) unroofed catheters vs. continuity of the unroofed catheters and, b) no unroofed catheters vs. continuity of the unroofed catheters (Log-rank test) (signifi cance value P< 0.05). Results: 1) The overall catheter survival rates were 94%, 84%, 76%, 55%, 40% and 26% at 12, 36, 60, 84, 120 and 210 months respectively. 2) The not unroofed catheter survival rates were 93%, 83%, 77%, 59%, 44% and 44% at 12, 36, 60, 84, 120 and 210 months respectively. 3) The unroofed catheter survival rates were 84%, 53%, 31%, 23% and 9% at 12, 36, 60, 84 and 120 months respectively. 4) The post-unroofed catheters survival rates were 91%, 77%, 66%, 66%, 50% and 33% at 12, 36, 60, 84, 120 and 160 months respectively. We detected a statistical signifi cance when comparing unroofed catheters vs. continuity of the unroofed catheters and no statistical signifi cance was observed when comparing not unroofed catheters vs. continuity of the unroofed catheters post-unroofed. Conclusion: The overall catheter survival was satisfactory. Unroofi ng contributed signifi cantly in the lifespan of the catheters.

Intraperitoneal vancomycin absorption is higher when there is peritoneal infl ammation, but the absorption decreases with recovery from peritonitis. Consequently, intraperitoneal maintenance doses are ineffective, reducing the rate of cure. Aim:To evaluate the outcome of Gram-positive peritonitis treated with intraperitoneal and subsequent intravenous vancomycin. Methods:In April 1996, we initiated a protocol for treating peritonitis caused by Gram-positive organisms using a 2-g intraperitoneal loading dose of vancomycin followed by intravenous vancomycin at 1 g twice in 5 days for coagulase-negative Staphylococcus and at 1 g three times in 5 days for Staphylococcus aureus. We analyzed episodes of Gram-positive peritonitis (coagulase-negative and S. aureus) and the effi ciency of the treatment protocol in 113 patients undergoing peritoneal dialysis between 1 April, 1996 and 3 August, 2016. There were 6090 patient-months and the mean treatment lasted 54±44 months. The outcomes were evaluated as (1) complete cure, (2) relapsing peritonitis, (3) catheter removal for refractory peritonitis, and (4) death.Results: A total of 51 cases of coagulase-negative Staphylococcus peritonitis and 37 of S. aureus were seen in 46 of the 113 patients (40.7%). Of these, coagulase-negative Staphylococcus (92.15%) and 34 S. aureus peritonitis (91.89%) resolved. Conclusion:The response to treatment was very satisfactory.