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Early surgical intervention of peritoneal dialysis catheter-related Pseudomonas peritonitis

Celeste Sharon Chang1, Han-Hsiang Chen, Hsiang-Chung Liu

  • 1Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.

Southern Medical Journal
|May 25, 2011
PubMed

Insights

Two challenging cases of Pseudomonas peritonitis in peritoneal dialysis (PD) patients highlight the need for surgical intervention when antibiotics fail. Prompt diagnosis and source control are crucial for managing persistent infections.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Surgical Gastroenterology

Background:

  • Peritoneal dialysis (PD) is a common treatment for end-stage renal disease.
  • Catheter-related infections, such as Pseudomonas peritonitis, can complicate PD therapy.
  • Standard treatment involves antibiotics and, often, catheter removal.

Observation:

  • Two PD patients developed severe Pseudomonas peritonitis resistant to standard antibiotic treatment and catheter removal.
  • Infections persisted, leading to intractable intra-abdominal and potentially extra-abdominal spread.
  • Emergency exploratory laparotomy with extensive peritoneal lavage and drainage was required.

Findings:

  • Surgical intervention, including lavage and drainage, led to dramatic recovery in both patients.
  • Patients were permanently transferred to hemodialysis post-surgery.
  • These cases demonstrate the potential for PD-related infections to become persistent and widespread.

Implications:

  • Persistent intra-abdominal infections in PD patients may require aggressive surgical management.
  • Early diagnosis and timely surgical source control are critical for successful outcomes.
  • Consideration of surgical intervention is important for refractory cases of PD-related peritonitis.

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