Cuff-Shaving and NPWT Promising For Managing Refractory Peritoneal Dialysis Catheter Infections: Study Reveals

The research published in BMC Nephrology revealed that combining cuff-shaving (CS) with negative pressure wound therapy (NPWT) is essential for eliminating infection sources and greatly enhancing the durability of PD catheters. This integrated surgical approach presents a promising method for managing persistent exit-site and tunnel infections in PD patients.

Refractory ESI and TI pose significant complications for patients on peritoneal dialysis, often leading to prolonged infections and jeopardizing the function of PD catheters. Traditional treatments have sometimes proven inadequate in managing these persistent issues, prompting the need for more effective strategies. Jiaxiang Ding, Life Science Park of Zhongguancun, Changping District, Beijing, P.R. China, and colleagues compared the outcomes of surgical intervention, notably the cuff-shaving procedure coupled with negative-pressure wound therapy, and conservative management strategies for patients with refractory ESI and TI.

For this purpose, the researchers retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. They assessed and compared treatment outcomes by examining ESI scores, ESI and TI frequency, identification of causative microorganisms, and the duration of catheter survival or the time until catheter removal.

The following were the key findings of the study:

• 97 episodes of catheter-related ESI and/or TI across 71 patients were identified with an incidence rate of 0.15 episodes per patient-year.
• Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management.
• In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely.
• The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months).
• Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival.

The findings showed that for persistent exit site infections and tunnel infections, especially those caused by Staphylococcus aureus, a combination of surgical removal of the superficial catheter segment and negative pressure wound therapy can be highly effective.

"This method helps to address and eliminate inflammatory lesions, thereby extending the catheter’s usability. Given the severe prognosis and increased risk of peritonitis with Staphylococcus aureus infections, timely intervention is essential for better patient outcomes," the researchers wrote.

"Additional research is required to determine the best timing for surgery involving excised external cuffs and to assess the long-term effects of combining catheter removal with negative pressure wound therapy (NPWT) and tunnel reconstruction on catheter survival," they concluded.

Reference:

Yang, Q., Ren, X., Fang, X. et al. The efficacy of cuff-shaving combined with negative pressure wound therapy in refractory exit-site and tunnel infections: a single center experience. BMC Nephrol 25, 273 (2024). https://doi.org/10.1186/s12882-024-03714-8