The decision whether to remove a peritoneal dialysis catheter in a patient with peritonitis can be difficult.
Patient selection: peritonitis associated with peritoneal dialysis
Situation
Catheter Removal
bacterial exit site and/or tunnel infection, refractory or relapsing
remove and replace immediately
bacterial peritonitis, concurrent exit site and/or tunnel infection with the same organism
remove with delayed replacement
bacterial peritonitis, refractory
bacterial peritonitis, relapsing
bacterial peritonitis, repeated
possibly remove with delayed replacement
bacterial peritonitis, surgical (multiple enteric bacteria secondary to intra-abdominal abscess, diverticulitis, etc)
fungal peritonitis
mycobacterial peritonitis
where:
• Coagulase-negative Staphylococci isolated on culture may or may not be pathogenic.
• Delayed replacement is typically done after 2-3 weeks. Mycobacterial infections require 6 weeks.
• For surgical peritonitis replacement of the catheter depends on the management of the intra-abdominal process.
• A catheter replacement immediately should use a different exit site and tunnel.
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Specialty: Infectious Diseases, Surgery, general, Gastroenterology
