Simultaneous removal and replacement of infected peritoneal dialysis catheters.

Infection is an important complication of peritoneal dialysis that often limits technique survival. Recurrent episodes of peritonitis caused by the same organism may be the result of catheter infection, necessitating removal. We performed 34 single-step catheter replacement procedures in children and young adults for recurrent peritonitis or refractory exit site and tunnel infections. The success rate of the procedure was high (85%), with rare instances of intraoperative contamination. The presence of Staphylococcus aureus infection or exit site and tunnel infection were not risk factors for worse outcome. All patients continued on peritoneal dialysis through catheter change without requiring interval hemodialysis. Eighteen peritoneal dialysis catheters were replaced in a staged procedure with an interval off peritoneal dialysis. There was one early reinfection of the new catheter. Patients with Pseudomonas sp infections were more likely to be treated with a staged procedure; S aureus infections were equally likely to be managed by staged or simultaneous catheter removals. Simultaneous removal and replacement of infected peritoneal dialysis catheters is an effective management strategy when compared with two-step catheter replacements.