From the Research
Peritoneal catheter infections should be treated promptly with antibiotics targeting the most common causative organisms, primarily Staphylococcus species, as recommended by the most recent study 1. The initial empiric therapy should include vancomycin and a third-generation cephalosporin, such as ceftazidime, to cover both gram-positive and gram-negative organisms, as suggested by 2. For exit site infections, add topical antibiotic application such as mupirocin ointment three times daily. Treatment duration is typically 2-3 weeks, with adjustments based on culture results. The catheter may need removal if there is tunnel infection, persistent infection despite appropriate antibiotics, or peritonitis, as indicated by 3 and 4. Prevention strategies include:
- Meticulous exit site care with daily cleaning using chlorhexidine or povidone-iodine solution
- Proper hand hygiene before handling the catheter
- Application of prophylactic mupirocin at the exit site, which can reduce the risk of exit site infection by 46%, as shown in 2 Peritoneal catheter infections are serious complications of peritoneal dialysis that can lead to peritonitis, catheter loss, and transition to hemodialysis if not managed effectively, highlighting the importance of prompt treatment and prevention strategies, as emphasized by 5 and 1. Early recognition of symptoms such as erythema, tenderness, or drainage at the exit site is crucial for timely intervention and improved outcomes. In cases of refractory tunnel infections, mini-invasive surgical techniques, such as curettage or cuff-shaving, may be considered to rescue the catheter, as proposed by 3. However, if these measures fail, catheter removal and replacement may be necessary to prevent further complications, as suggested by 1 and 4.