An approach to treat refractory catheter-related infections in patients undergoing peritoneal dialysis: tunnel-reconstruction operation

Background A refractory catheter-related infection in patients receiving peritoneal dialysis (PD) represents a major challenge that may require catheter removal and reinsertion. We assessed the effect of a tunnel reconstruction operation on refractory infection in a single center.Methods We retrospectively collected data from 10 PD patients who, after inadequate responses to treatment with culture-based antibiotic therapy, underwent a tunnel reconstruction operation designed to resolve a refractory catheter-related infection without requiring transition to hemodialysis. The patients were followed for 3–41 months, and outcomes at months 3 and 12 were analyzed.Results Tunnel reconstruction surgery was performed in 10 patients, including 7 with exit-site infection and 3 with tunnel infection. No patients developed catheter-related infection, catheter dysfunction, or postoperative complications after 3 months of postoperative follow-up. During the 12-month postoperative follow-up period, there were no catheter-related infections among 7 patients (3 patients were not followed for 12 months). However, 2 patients developed an exit-site infection episode at 33 and 41 months after tunnel reconstruction surgery, respectively. No incidents of PD connector hypersensitivity or catheter leakage occurred during the follow-up period.Conclusion Tunnel reconstruction operation may be a promising salvage option that requires prospective validation in PD patients with refractory catheter-related infections.