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PD Tunnel Infection Catheter Removal Mandatory — ESENeph MCQ

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ModeratePeritoneal DialysisPD Tunnel Infection Catheter Removal MandatoryESENeph

A 72-year-old man on peritoneal dialysis has a PD-related exit site infection that has not responded to 3 weeks of oral flucloxacillin. Culture shows methicillin-sensitive Staphylococcus aureus (MSSA). There is now purulent discharge tracking along the subcutaneous tunnel. Ultrasound confirms a tunnel abscess. What is the required management?

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Correct answer: E — PD catheter removal and temporary switch to haemodialysis

A tunnel infection (abscess tracking along the subcutaneous tunnel of the PD catheter) is an indication for catheter removal per ISPD 2022 guidelines. Unlike simple exit site infections (which can be managed with topical and oral antibiotics), tunnel infections reflect deep-seated catheter-associated infection that cannot be eradicated without removing the foreign body. The patient should be transferred to temporary haemodialysis. After a 2-3 week antibiotic course following catheter removal and resolution of infection, a new PD catheter can be inserted on the contralateral side if PD is desired. Incision and drainage alone without catheter removal has high failure rates.

Reference: ISPD 2022 – Exit Site and Tunnel Infection Guidelines; UKKA 2019 – PD Complications