title: Treatment of refractory pseudomonas aeruginosa exit-site infection by simultaneous removal and reinsertion of peritoneal dialysis catheter.
abstract: BACKGROUND
  Patients on continuous ambulatory peritoneal dialysis (CAPD) with Pseudomonas aeruginosa exit-site infection (ESI) refractory to antibiotic treatment often require replacement of their peritoneal dialysis catheter (PDC). The optimal interval between removal and reinsertion of the PDC is not known. There are relatively few data on the feasibility of simultaneous removal and reinsertion of dialysis catheters for the treatment of P. aeruginosa ESI.
  
  
  METHODS
  We retrospectively reviewed the short- and long-term outcomes of all CAPD patients who had undergone simultaneous removal and reinsertion of their PDC for the treatment of refractory P. aeruginosa ESI in our hospital between January 1994 and December 2003. During the operation, the old catheter was removed first and a new catheter was inserted into the opposite side of the abdomen. All patients received 7 days of antibiotic therapy postoperatively. CAPD was resumed after 2 weeks of intermittent peritoneal dialysis.
  
  
  RESULTS
  Over a 10-year period, 37 CAPD patients underwent the operation. Mean age of the patients was 59.5 +/- 10.9 years. The interval between the diagnosis of ESI and the operation was 16.7 +/- 6.9 weeks. The patients received 7.6 +/- 2.5 weeks of antibiotic treatment before the procedure. Early postoperative complications were uncommon. None of the patients developed ESI within 4 weeks after the operation. At 1 year after the operation, 3 patients (8%) had developed recurrence of P. aeruginosa ESI 24 - 40 weeks postoperatively. Peritonitis due to P. aeruginosa was not observed.
  
  
  CONCLUSIONS
  We conclude that simultaneous removal and reinsertion of the PDC is feasible in eradicating refractory ESI due to P. aeruginosa. This procedure alleviates the need for temporary hemodialysis and allows continuation of peritoneal dialysis.
authors.affiliation: Division of Nephrology, University Department of Medicine, Tung Wah Hospital, 12, PoYan Street, Sheung Wan, Hong Kong SAR, People's Republic of China. sllui@hku.hk
authors.forename: Sing Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.forename: Kai Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Man Fai
authors.initials: MF
authors.lastname: Lam
authors.forename: Kar Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D020878:Device Removal / Q000379:methods*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000628:therapy*; D011552:Pseudomonas Infections / Q000209:etiology / Q000628:therapy*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome