NEW CRITERIA FOR MANAGEMENT OF CATHETER INFECTIONS IN PERITONEAL-DIALYSIS PATIENTS USING ULTRASONOGRAPHY

Catheter-related infection is one of the most important causes of tech nical dropout in peritoneal dialysis patients. Both the type of cultur ed organism and the extent of inflammation are well known prognostic f actors for the outcome of these infections. From December 1993 to Nove mber 1996, 96 catheter-related infections without simultaneous periton itis occurred in 49 of 86 peritoneal dialysis patients treated in this study. During the observation period, only single-cuff catheters were used. Staphylococcus aureus was the most common organism cultured (51 %), Involvement of the tunnel was diagnosed by sonography in 57.1% of all Staphylococcus aureus cases, but only in 26.1% of Staphylococcus e pidermidis-related exit-site infections. Ten of the 96 catheter-relate d infections (10.4%) resulted in catheter loss, Catheter removal was n ecessary only in cases of deep tunnel infection caused by Staphylococc us aureus. The number of gram-negative catheter infections was too sma ll to allow conclusive analysis. Although sonography of the catheter t unnel is now well established in the early diagnosis of tunnel infecti ons, no clear guidelines exist for management of these infections. In this study, patients with deep tunnel infection who did not require ca theter removal showed a significant decline of the hypoechogenic ar ea around the cuff (from 7.02 +/- 0.70 to 3.75 +/- 1.04 mm. P < 0.002) 2 wk after initiation of therapy. No significant decline was observed i n patients who later lost their catheters. On the basis of these data, it is concluded that in cases of exit-sire and superficial tunnel inf ection, conservative treatment should be performed. In cases of deep t unnel infection without peritonitis caused by Staphylococcus aureus, a ntibiotic treatment should be started and sonographic examination shou ld be performed ever?: second week, If the hypoechogenic ru ea around the cuff decreases (>30%), conservative treatment should be prolonged. In cases without sonographic improvement (<30%)2 wk after therapy, ca theter removal is recommended.