Purpose : Continuous ambulatory peritoneal dialysis(CAPD) is a well established treatment modality for renal replacement therapy in end stage. renal disease. The infectious complications associated with CAPD have been major problems in the management of CAPD. Of those the exit-site or cuff infection has become an important cause of catheter removal. To evaluate whether the shaving of external cuff is effective treatment in the patients with refractory exit site infection.
Methods : We reviewed 13 patients treated with the shaving of the external cuff due to persistant or refractory exit site infection not responsive to adequate antibiotic therapies more than 4 weeks. This review of cases included 1994~1998 in the Dongguk University Medical College Hospital and special attention was given to catheter survival after external cuff shaving.
Results :
1) The male to female ratio was 7: 6, and the mean age was 45.5±12.8 years.
2) The mean duration of CAPD before shaving was 21.68±7.97 months, and the underlying renal diseases were chronic glomerulonephritis(30.8%), diabetic nephropathy(23.1 %), hypertensive nephropathy(23.1 %) and polycystic kidney(7.7%).
3) Of the organisms isolated from exit site infections, Staphylococcus aureus was the most common before and after the shaving with 53.9% and 15.4% of all culture positive infections respectively.
4) The mean catheter survival after the shaving was 17.63±6.26 months(mean±SD) from 9 to 28 months. The annual incidence of exit infection and peritonitis were 205±1.42 and 0.21±0.33, before the shaving and 0.68±0.87 and 0.28±0.35 after the shaving respectively.
Conclusion : The persistent or refractory exit-site infection in CAPD patients have been treated by removal of infected catheter. However, with the above results, we found-that the shaving of the external cuff in those patients can maintain the catheter for a relatively long period(mean 17.63±626 months, range 9~28 months). After the shaving of external cuff, the patients were clinically stable without a significant increase in exit-site infection or peritonitis.
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