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Surgical treatment of persistent exit-site infections
J D Glickman1, T Rafanello, R E Gerhardt
1Pennsylvania Hospital, Philadelphia, USA.
Abstract:
Persistent exit-site infections and tunnel infections (ESI/TI) are a cause for removal of Swan neck catheters (SNC). Previous studies report variable success in the treatment of these infections by surgical exposure and removal of the subcutaneous external cuff. We report our experience with this technique. All 5 patients with persistent ESI/TI were successfully treated with antibiotics and surgical intervention. All cultures grew Staphylococcus aureus. Average time to complete healing after surgical exposure was 39.4 days. Mean follow-up after complete healing was 164.8 days. There were no subsequent episodes of ESI/TI in these patients. None of the catheters subsequently malfunctioned or developed leaks. Persistent ESI/TI in Swan neck catheters can be successfully treated with surgical exposure and removal of the subcutaneous external cuff.
Insights
Persistent exit-site and tunnel infections (ESI/TI) in Swan neck catheters (SNC) can be successfully treated. Surgical removal of the cuff combined with antibiotics resolved infections in all patients, preventing recurrence.
Area of Science:
- Nephrology
- Infectious Diseases
- Surgical Innovation
Background:
- Persistent exit-site infections and tunnel infections (ESI/TI) often necessitate the removal of Swan neck catheters (SNC).
- Previous treatments involving surgical exposure and cuff removal show variable success rates.
- Staphylococcus aureus is a common pathogen in catheter-related infections.
Purpose of the Study:
- To evaluate the efficacy of surgical exposure and subcutaneous external cuff removal in treating persistent ESI/TI in SNC.
- To assess the outcomes and recurrence rates following this intervention.
Main Methods:
- A cohort of 5 patients with persistent ESI/TI underwent surgical intervention.
- The surgical procedure involved exposure and removal of the subcutaneous external cuff.
- All patients received antibiotic treatment concurrently.
Main Results:
- All 5 patients achieved successful treatment of persistent ESI/TI.
- Staphylococcus aureus was identified in all positive cultures.
- Average healing time post-surgery was 39.4 days, with a mean follow-up of 164.8 days.
- No subsequent ESI/TI episodes or catheter malfunctions were observed.
Conclusions:
- Surgical exposure and removal of the subcutaneous external cuff, combined with antibiotics, is an effective treatment for persistent ESI/TI in SNC.
- This approach leads to complete healing and prevents long-term complications and recurrence.