Catheter salvage using revision for a peritoneal dialysis catheter with intractable exit site and/or tunnel infections

Abstract

Background In case of intractable exit site and/or tunnel infections, peritoneal dialysis (PD) catheter removal and re‐insertion are recommended. Previous studies have reported the possibility of catheter salvage before removal, but they were either case‐series or had a small sample size. Methods We identified all incident patients with PD who underwent revision at a tertiary medical center. In intractable exit site and/or tunnel infections, we tried catheter revision using a method with cuff shaving, using an original catheter, and creating a new tunnel. Revision success was defined as complete remission over more than 1 month after revision. We evaluated the infection‐free and catheter survival rates. Results In total, 52 patients with PD underwent revision. The median age at the time of revision in the patients undergoing PD was 51 (21) years. There were 43 (82.7%) cases of revision success. Infection‐free survival rates at 6 and 12 months were 57.0% and 35.1%, respectively. Catheter survival rates at 12 and 36 months were 72.5% and 56.2%, respectively. Conclusion The present study demonstrated that catheter revision can be a useful bridging method for original catheter salvage before catheter removal in intractable exit site and/or tunnel infections.

ISPD Catheter-related Infection Recommendations: 2023 Update

“…In the literature, refractory tunnel infection has even been defined as failure to heal within 4 weeks. 15 Catheter-related infections that fail to completely resolve following the recommended antibiotic course duration can be defined as refractory catheter-related infections, thereby necessitating surgical salvage interventions or catheter removal.…”

“…126,127 There have been four or more single-centre observational studies that suggest a potential benefit of relocating the exit site in patients with exit site infection refractory to antibiotics. 15,124,125,127 Catheter exit site relocation success, defined as complete remission of infection not requiring additional procedures beyond 1 month after the revision, was 83% out of 52 patients, 15 90% out of 33 patients 127 and 69% out of 36 patients. 125 Although there are no RCTs comparing different strategies, the median PD catheter survival was 84 months, statistically higher than 49 months among a comparative group treated conservatively, in one observational study.…”

“…Finally, the benchmark for exit site infection rate, which may in the long run drive the PD community to develop more effective preventive strategies, has not yet been precisely established. Catheter diversion with cuff shaving 125,136 Dirty 2 47/51 (92.2%) Unroofing, wound excision or en bloc resection with cuff shaving 15,120,121,128,130,137,138 Dirty 7 120/185 (64.9%) a Surgical wound is classified using the National Healthcare Safety Network wound class 139 as clean, clean-contaminated, contaminated or dirty/infected (referring to old wounds with retained devitalised tissue and those that involve existing clinical infection, suggesting that organisms causing postoperative infection were present in the operative field before the operation).…”

Traduction française de «Recommandations de l’ ISPD sur les infections liées au cathéter : Mise à jour 2023. »

“…[126,127]. Il y a eu au moins quatre études observationnelles monocentriques qui suggèrent un bénéfice potentiel de la relocalisation du site de sortie chez les patients présentant une infection du site de sortie réfractaire aux antibiotiques [15,124,125,127]. Le succès de la relocalisation du site de sortie du cathéter, défini comme une rémission complète de l'infection ne nécessitant pas de procédures supplémentaires au-delà d'un mois après la révision, était de 83 % sur 52 patients [15], 90 % sur 33 patients [127] et 69 % sur 36 patients [125] .…”

“…Il y a eu au moins quatre études observationnelles monocentriques qui suggèrent un bénéfice potentiel de la relocalisation du site de sortie chez les patients présentant une infection du site de sortie réfractaire aux antibiotiques [15,124,125,127]. Le succès de la relocalisation du site de sortie du cathéter, défini comme une rémission complète de l'infection ne nécessitant pas de procédures supplémentaires au-delà d'un mois après la révision, était de 83 % sur 52 patients [15], 90 % sur 33 patients [127] et 69 % sur 36 patients [125] . Bien qu'il n'y ait pas d'ECR comparant différentes stratégies, la survie médiane du cathéter de DP était de 84 mois, statistiquement plus élevée que les 49 mois d'un groupe comparatif traité de manière conservatrice, dans une étude observationnelle [127].…”