One-Stage Removal and Replacement of Tract-Infected Catheter in Continuous Ambulatory Peritoneal Dialysis Patients

Objective: Catheter-related infections represent a primary infectious complication in patients with continuous ambulatory peritoneal dialysis (CAPD). A one-stage operation or two-stage procedure can be taken to remove and replace the infected catheter in CAPD patients. We retrospectively compared clinical features and outcomes between two surgical groups between 1994 and 2003 at National Cheng Kung University Hospital. Methods: We performed the two-stage procedure to replace infected catheter before 1997. In 1997, we began to adopt a one-stage surgical procedure to treat CAPD patients who had exit-site (ES) or tunnel (T) infections, but the conventional two- stage operation was performed for patients with peritonitis. During this study period from 1994 to 2003, 10 patients received the one-stage operation (eight with ES infection and two with T infection) while the other 10 patients (five with ES/T infections and five with peritonitis) received the two-stage procedure. After insertion of new catheters, the patients underwent substitutive hemodialysis therapy for 10 days prior to restarting CAPD and were subsequently followed up for at least three months. Results: The patients receiving the one-stage operation showed no significant differences in the mean age, duration of antibiotic therapy prior to operation, and clinical outcome as compared with those receiving the two-stage procedure. The interval for substitutive hemodialysis therapy prior to restarting CAPD was 10.0±0.0 days for patients in the one-stage group. In the two-stage group, the mean durations of substitutive hemodialysis therapy were 31.2±8.4 days (P=0.001) for patients with ES/T infections and 56.2±12.3 days (P=0.001) for those with peritonitis, which were longer as compared with that in the one-stage group. Conclusion: The one-stage operation seemed to yield satisfactory results in treatment of CAPD patients with ES/T infections, and shortened the interval for substitutive hemodialysis, thus allowing an early return to CAPD as compared with the conventional two-stage surgery. It is more practical and may also be safe to use the one-stage operation to treat tract-infected catheter in CAPD patients.