Simultaneous catheter replacement and removal in refractory peritoneal dialysis infections

A salvage technique for continuous ambulatory peritoneal dialysis catheters with exit-site infections

Catheter infection is a major complication of continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease. Catheter exist-site infections were treated with a new surgical technique consisting of dissection and removal of the existing catheter in the subcutaneous layer, insertion of a catheter connector and new catheter piece, and creation of a new subcutaneous tunnel. The new surgery can be performed on an outpatient basis and allows for the continuation of CAPD, thereby avoiding the cost associated with inpatient admission and interim hemodialysis.

Managing Staphylococcus aureus catheter infection in continuous ambulatory peritoneal dialysis patients

A case of Staphylococcus aureus catheter infection in a patient on peritoneal dialysis is presented and discussed by nephrologists, a social worker, a nurse specializing in the care of peritoneal dialysis patients, and the patient involved. The focus of the multidisciplinary case discussion concerns the management of S aureus catheter infections, including catheter removal, psychosocial issues and the patient's response to the need for catheter removal, the risk factors and prevention of S aureus catheter infections in peritoneal dialysis patients, and exit site care practices.

Development of bacterial biofilms on silastic catheter materials in peritoneal dialysis fluid

A modified Robbins' device was used to monitor the growth of bacteria associated with clinical peritonitis in peritoneal dialysis fluid. To simulate bacterial colonization and biofilm formation on peritoneal catheters, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli were allowed to adhere to silastic disks and were then grown in fresh or used dialysis fluid. Adherent bacteria formed microcolonies and biofilms on silastics within 4 to 24 hours. Our data showed that colonization of the silastic disks was related to the quantity of bacteria and there were significant differences between the growth of adherent bacteria in fresh and used dialysis fluid. Adherent S epidermidis and P aeruginosa grew better in dialysis fluids than adherent E coli. These results suggest that S epidermidis and P aeruginosa are more likely to colonize silastic catheters and to cause catheter-related peritonitis in peritoneal dialysis patients than E coli.