Adjunctive Taurolidine-Citrate-Urokinase Lock Treatment for Peritoneal Dialysis-Associated Peritonitis: A Case Series of 13 Episodes

Background and objective: Evidence for adjunctive taurolidine-based catheter locks in peritoneal dialysis (PD) remains limited.We describe 13 previously unreported PD-associated peritonitis episodes, focusing on treatment feasibility, catheter retention, subsequent infection, PD continuity, and peritoneal equilibration test (PET) findings.Methods: This retrospective single-center series included all 13 PD-associated peritonitis episodes recorded in the unit between July 2025 and July 2026, involving 13 patients, with episode onset between July 9, 2025, and July 23, 2026.The administrative cutoff was September 1, 2026.Patients received intraperitoneal antibiotics in all dialysis exchanges for 21 days and three hospital-administered taurolidine-citrateurokinase lock instillations at approximately 5-7-day intervals, with antibiotic-containing dialysate remaining in the abdomen.Surveillance included weekly effluent leukocyte counts and cultures for four weeks after antibiotic completion.Analyses were descriptive; the four-week endpoint included only episodes with complete observation by the cutoff.Results: Cultures were positive in 11 (84.6%) and negative in two (15.4%)episodes.All 13 (100.0%)completed the lock schedule and had recorded clinical resolution with catheter retention during active infection; the exact 95% confidence interval for retention was 75.3%-100.0%.No relapsing or recurrent peritonitis was recorded among the 12 evaluable episodes at the cutoff; the upper limit of the two-sided exact 95% confidence interval was 26.5%.The remaining patient subsequently completed four-week surveillance without further peritonitis; this post-cutoff update was reported separately.Mild transient discomfort occurred in seven (53.8%) patients.Median observed follow-up in the original analysis was 241 days (interquartile range, 147-293; range, 40-419).Post-peritonitis PET was available at the cutoff for 12 patients, all of whom had an unchanged transport category.At the cutoff, 11 (84.6%)remained on PD, one had discontinued because of caregiver unavailability, and one had died from a stroke reported as unrelated to peritonitis.Conclusions: This series adds feasibility and follow-up observations on adjunctive lock treatment.Concurrent antibiotics, retrospective outcome assessment, and the absence of a comparator prevent attribution of benefit to the lock.The organism mix included infections that commonly respond to appropriate antibiotics alone.Intraluminal drug residence was not measured, and categorical PET stability does not establish membrane safety.Prospective comparative evaluation is needed, and this off-label approach must not delay guideline-indicated catheter removal.