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Pediatr Surg Int. 2009 Aug;25(8):703-7. doi: 10.1007/s00383-009-2412-0. Epub 2009 Jul 2.

Conservative surgical management of catheter infections in children on peritoneal dialysis.

Author information

1
Department of Pediatric Surgery, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via Commenda 10, 20122, Milan, Italy. francesco.macchini@unimi.it

Abstract

INTRODUCTION:

Major indications for peritoneal dialysis catheter removal include chronic exit-site infection (ESI) or tunnel infection (TI). No consensus on the optimal treatment of these infections in children exists.

PATIENTS:

During the last 10 years, 13 patients (7 females, mean age 56 months) on peritoneal dialysis were treated for recurrent ESI (N: 4) or TI (N: 9). Staphylococcus aureus (12 patients) and Pseudomonas aeruginosa (1 patient) were isolated. All patients had a double-cuff straight Tenchkoff catheter and underwent the shaving of the external cuff, with a new tunnel tightly adherent to the catheter, and an exit-site in the opposite abdominal region. A mean follow-up of 31 months/catheter demonstrated no recurrence of ESI and TI.

DISCUSSION:

Little pediatric experience with cuff shaving exists: reported catheter salvage rates are 48-100%. In our experience, good results were obtained by shaving off the external cuff and re-creating a new tunnel, with a different course, strictly adherent to the catheter. This measure seems to guarantee an effective barrier against infections, while obviating the need of the external cuff.

CONCLUSIONS:

Sometimes, in case of recurrent ESI or TI, the external cuff may facilitate the persistence of bacteria. A conservative surgical treatment offers good results in children.

PMID:
19572136
DOI:
10.1007/s00383-009-2412-0
[Indexed for MEDLINE]

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