ABSTRACT
In CAPD patients, exit site infection and peritonitis are occasionally not improved due to undetected tunnel infection. The diagnosis of tunnel infection is mainly based on the clinical symptoms and signs which seem insensitive for early diagnosis and timely intervention. We examined usefulness of catheter ultrasonography(USG) as a tool in the diagnosis of tunnel infection in various kinds of infectious complications in CAPD patients. Positive result was defined by the presence of hypoechoic area more than 2mm in diameter along the subcutaneous catheter tunnel. 26 USG were performed in 23 patients who represented normal in 4 cases, exit site infections in 6 cases, tunnel infections in 2 cases, peritonitis in 10 cases and 4 cases of combined infections. The mean age was 53.6 years and mean duration of CAPD and break-in period were 16.7 months and 24.7 days respectively. Positive USG findings were noted in 13 cases(50%). High rate of positive finding was observed in clinically suspected exit site infection (80.3%), tunnel infection(100%) and combined infections (75%). Positive results were most commonly observed near the external cuff area. The most common causative organism was S. aureus followed by Pseudomonas and CNS infections. S. aureus infection most likely resulted in positive sonographic findings and catheter loss despite of antibiotic treatment. We conclude that USG is a sensitive tool for the diagnosis of tunnel infections and tunnel infection caused by S. aureus is at high risk of catheter loss.
Subject(s)
Humans , Catheters , Diagnosis , Early Diagnosis , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Pseudomonas , UltrasonographyABSTRACT
In CAPD patients, exit site infection and peritonitis are occasionally not improved due to undetected tunnel infection. The diagnosis of tunnel infection is mainly based on the clinical symptoms and signs which seem insensitive for early diagnosis and timely intervention. We examined usefulness of catheter ultrasonography(USG) as a tool in the diagnosis of tunnel infection in various kinds of infectious complications in CAPD patients. Positive result was defined by the presence of hypoechoic area more than 2mm in diameter along the subcutaneous catheter tunnel. 26 USG were performed in 23 patients who represented normal in 4 cases, exit site infections in 6 cases, tunnel infections in 2 cases, peritonitis in 10 cases and 4 cases of combined infections. The mean age was 53.6 years and mean duration of CAPD and break-in period were 16.7 months and 24.7 days respectively. Positive USG findings were noted in 13 cases(50%). High rate of positive finding was observed in clinically suspected exit site infection (80.3%), tunnel infection(100%) and combined infections (75%). Positive results were most commonly observed near the external cuff area. The most common causative organism was S. aureus followed by Pseudomonas and CNS infections. S. aureus infection most likely resulted in positive sonographic findings and catheter loss despite of antibiotic treatment. We conclude that USG is a sensitive tool for the diagnosis of tunnel infections and tunnel infection caused by S. aureus is at high risk of catheter loss.