Peritoneal dialysis catheter removal for acute peritonitis: A retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization

Background Most patients with acute peritoneal dialysis (PD) peritonitis respond to antibiotic therapy, but a significant minority of patients require surgical catheter removal to eradicate the infection. These patients may experience an adverse postsurgical course. Methods: We retrospectively analyzed 64 episodes of acute peritonitis requiring PD catheter removal in comparison to 426 episodes treated with antibiotics alone. Results: There were no differences between patients who required PD catheter removal and medically treated patients in sex (62% versus 60% men; P > 0.05), PD modality (31% versus 27% automated PD; P > 0.05), time spent on PD therapy (35 versus 26 months; P > 0.05), or cause of end-stage renal failure. Catheter removal was more likely to occur in elderly (mean age, 61 versus 54 years; P = 0.023) and South Asian patients (38% versus 22%; P = 0.020) and after peritonitis caused by Escherichia coli (16% versus 4%; P = 0.0005), Enterobacter species (5% versus 0.7%; P = 0.031), and Pseudomonas species (5% versus 0.7%; P = 0.031). The most significant correlation with requirement for surgical catheter removal was duration of peritonitis (mean, 7.5 versus 2.8 days; P = 1.3 x 10(-8)). Fifty-three percent of catheter removals resulted in postoperative hospitalization longer than 10 days. Delayed discharges were caused by multiple reasons. Compared with discharges within 10 days, prolonged hospitalization was associated with increased age (mean, 64 versus 58 years; P = 0.028) and delay in time to catheter removal (mean, 7.9 versus 5.3 days; P = 0.027). After catheter removal, only 4% of patients successfully returned to maintenance PD therapy. Conclusion: Increased age and duration of peritonitis are associated with both requirement for PD catheter removal and prolonged postoperative hospitalization.