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.

Conservative surgical management of catheter infections in children on peritoneal dialysis / F. MacChini, S. Testa, A. Valade, M. Torricelli, E. Leva, G. Ardissino, A. Edefonti. - In: PEDIATRIC SURGERY INTERNATIONAL. - ISSN 0179-0358. - 25:8(2009 Aug), pp. 703-707.

Conservative surgical management of catheter infections in children on peritoneal dialysis

F. MacChini;M. Torricelli;E. Leva;G. Ardissino;
2009-08

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. © 2009 Springer-Verlag.
Cuff shaving; Exit-site infection; Peritoneal dialysis; Tunnel infection
Settore MED/20 - Chirurgia Pediatrica e Infantile
lug-2009
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/758006
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