Simultaneous removal and replacement of the peritoneal dialysis catheter in a relapsing Pseudomonas peritonitis patient

Relapsing peritonitis is often linked to the colonization of the catheter with the presence of a biofilm in its intra-abdominal portion that should lead to catheter replacement. Peritoneal dialysis (PD)-related peritonitis due to Pseudomonas aeruginosa (P. aeruginosa) often develops into relapsing peritonitis, and often need to remove the PD catheter. P. aeruginosa peritonitis is often severe and associated with less than 50% complete cure rate, often requiring catheter removal, and transfer to hemodialysis (HD). To avoid the shift to HD, the simultaneous removal and replacement of the peritoneal catheter (SCR) has been employed to treat relapsing peritonitis. At present there is growing evidence that relapsing peritonitis can be sustained by bacterial adherence along the intraperitoneal portion of the catheter, especially when Pseudomonas species are involved, which is not recommended to be treated with SCR by some authors. Herein, we describe a case of relapsing P. aeruginosa peritonitis that has been successfully treated by SCR, with the new catheter placed on the contralateral side. However, the factors, negative dialysis fluid cultures, normalization of effluent white cell count, decrease in CRP, may have contributed to the success of SCR in this case, and we believe this approach can be safe when the procedure is used for mechanical complications, while it might be at risk in the event of infectious complications.