Conservative surgical management of catheter infections in children on peritoneal dialysis

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. © 2009 Springer-Verlag.