Simultaneous removal and replacement of the peritoneal catheter in PD patients with partial refractory peritonitis

In patients on peritoneal dialysis (PD) peritonitis continues to be the main cause of PD-related death, and the leading reason of transfer to hemodialysis (HD). International guidelines recommend that peritoneal catheter should be removed if PD effluent does not clear after 5 days of adequate antibiotics defining the case as refractory peritonitis. The simultaneous removal and replacement of the peritoneal catheter (SCR) has been used as treatment for recurrent or catheter-related peritonitis after the utter healing of the acute infection to spare patient the interruption of PD and the transfer to HD. On the other hand, in case of refractory episodes the employment of SCR is discouraged. However, the clinical trend of refractory peritonitis is not homogenous: some episodes are totally unresponsive to medical therapy, while others show to be partially responsive. Thus, the treatment should be diversified according to the different clinical evolution. We report two cases of refractory peritonitis sustained by P. aeruginosa that were successfully treated by SCR after a partial response to antibiotic therapy. Along with these preliminary data, we propose a novel therapeutical algorithm differentiating between complete refractory peritonitis and partial refractory peritonitis.