Catheter-related infections in peritoneal dialysis patients: New aspects

Catheter-related infections remain a major cause of technical dropout in pe ritoneal dialysis patients. Staphylococcus aureus (S. aureus) is the most i mportant causative organism of these infections. The objective of this pape r is to give an overview of recent developments in the prophylaxis and ther apy of infectious catheter complications. It has been shown that prophylact ic therapy, with mupirocin or rifampin, results in a decrease of catheter-r elated infections. However, due to clinical problems associated with longte rm antibiotic therapy, prophylactic treatment should be restricted to patie nts at high risk of developing these infections, such as diabetic exit-site carriers, immunosuppressed patients and non-diabetic, nonimmunosuppressed patients with two or more S. aureus positive nasal cultures. The prognosis of catheter-related infections depends on the respective organism and the e xtent of inflammation. Tunnel sonography is of major importance for early d iagnosis of tunnel involvement and for estimating the outcome of tunnel inf ections. In patients with deep tunnel infection showing marked sonographic improvement two weeks after starting therapy, antibiotic treatment should b e prolonged, whereas lack of sonographic improvement is associated with a h igh risk of catheter loss. In patients with tunnel infection and simultaneo us peritonitis, catheter removal is recommended.