The Effect of Simultaneous Catheter Removal and Replacement for Recurrent Peritonitis and Catheter-related Infections in Peritoneal Dialysis Patients / 대한신장학회잡지

BACKGOUND: Recurrent peritonitis and catheter-related infection, in which removal of the PD catheter and temporary hemodialysis are required, are the main cause of limited technical survival in peritoneal dialysis (PD). The aim of this study was to verify whether the simultaneous catheter removal and replacement (SRR) is feasible and safe in patients with recurrent peritonitis and catheter-related infection. METHODS: From January 2001 to December 2004, We performed 47 SRR in 42 PD patients for the treatment of recurrent peritonitis and catheter-related infection to avoid the interruption of PD. RESULTS: Indications for SRR were recurrent peritonitis in 16 (34.0%), catheter infection without peritonitis in 16 (34.0%), catheter infection with peritonitis in 11 (23.5%) and peritonitis with dialysate leakage in 4 (8.5%). SRR was successful in 89.4%. However, SRR was failed in 10.6% due to persistent tunnel infection in three, drainage failure and hernia in each one. PD was continued after SRR during 14.5+/-11.8 months and subsequent catheter longevity ranged from 3 to 47 months. The most common causative organism of recurrent peritonitis and catheter-related infection was MRSA (25.5%). Subsequent peritonitis occurred in 52.4% of patients with the mean of 10.5+/-9.6 months after SRR. However, 81.8% of subsequent peritonitis were due to new organisms. Postoperative complications occurred in 16 cases (34.0%) including five cases with dialysate leakage, four with persistent tunnel infection, four with early peritonitis, two with drainage failure and one with bleeding. CONCLUSION: We conclude that SRR is a safe and effective procedure in patients with recurrent peritonitis and catheter-related infection without the interruption of PD.

A Case of Recurrent Peritonitis Associated with Colon Cancer in a Continuous Ambulatory Peritoneal Dialysis Patient / 대한신장학회잡지

Recurrent peritonitis is the major complication of continuous ambulatory peritoneal dialysis (CAPD) and a common reason for discontinuation of this form of therapy. Polymicrobial peritonitis by gram- negative organisms suggests intraabdominal pathology not directly associated with CAPD, necessitating early removal of catheter and/or abdominal exploration. The source of infection may still be gastrointestinal, especially in light of the polymicrobial gram-negative peritonitis and rarely be gastrointestinal malignancy. We recently experienced a case of 64-year-old woman with recurrent CAPD peritonitis by polymicrobial gram-negative organisms, originated from colon cancer. Colon cancer was confirmed by barium enema, abdominal CT and colonoscopic biopsy. She underwent right hemicolectomy and removal of catheter simultaneously. The biopsy revealed a moderately to poorly differentiated adenocarcinoma with abundant mucin production.

Clinical Characteristics of Relapsing Peritonitis in CAPD Patients / 대한신장학회잡지

Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheter-related infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were: 1) to analyze the causative pathogen; 2) to determine the appropriate treatment regimen and duration; and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culture-positive. The distribution of isolates was as follows : coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphylococcus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46 (50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Gram-positive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy with vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylococcal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.