#1438 Review of the use of peritoneal catheter sealing in peritonitis
Authors: Parejo Cristina García , Nájera Ángela Eraso , Martín Álvarez Blanca , Caballero Fernando Martín , García Luisa Gemma Sánchez , Torres María Verónica , Vargas Anney Yelena Rosario , Tejeda Nathalie Martínez , Anachuri Karina Ampuero , Espinoza Danay Areli Ticona , Giralda Belén Gómez , Alaguero del Pozo María Begoña 
Published: May 2024

Background and Aims

Relapsing peritonitis is a new episode of peritonitis caused by the same microorganism occurring less than 4 weeks after the end of treatment of the previous one. It is associated with the formation of biofilm formation in the lumen of the peritoneal catheter and may lead to its removal. It is associated with increased technique failure, morbidity and mortality and health care costs.

The aim of this study is to demonstrate the efficacy of peritoneal catheter sealing with taurolidine-heparin (T-H) in the prevention of relapsing peritonitis and thus avoid more aggressive measures in these cases, such as catheter removal.

Method

We performed a single-center retrospective analysis study. We analyzed episodes of peritonitis in our peritoneal dialysis (PD) unit over a 5-year period from January 1st 2019 to December 31st 2023. We collected demographic data and risk factors during this period: age, sex, CKD etiology, diabetes, modality, assisted PD, and S. aureus nasal carrier status.

We documented peritonitis during the period, causative germs, treatment performed, and catheter sealing. We documented sealing patterns and evolution (cure, recurrence, catheter removal).

We performed T-H sealing with a full abdomen and once the treatment had been completed. The catheter sealing with antibiotics was performed right after the intraperitoneal antibiotics’ doses during the treatment.

Results

We analyzed a total of 84 patients. Demographic characteristics were: mean age 66.5 years (range 24-88 years), 71.4% male, 28.6% diabetic, 45.2% on APD, 11.9% assisted PD, 5.9% nasal S. aureus carriers. Etiology of CKD: 66.7% unaffiliated etiology, 11.9% glomerulonephritis, 7.1% ADPKD, 5.9% chronic tubulo-interstitial nephritis and 1.2% vasculitis, multiple myeloma, anephritis, acute tubular necrosis, lupus, Alport syndrome and nephronophthisis.

There were 71 episodes of peritonitis, in 32 patients. The causative germs were: 36.6% coagulase negative staphylococci, 21.1% streptococci, 19.7% negative culture, 7% enterobacteria, 7% polymicrobial, 4.2% S. aureus, 2.8% enterococci and 1.4% corynebacteria.

We performed some type of sealing in 47 peritonitis cases: 34% with antibiotic alone, 21.3% with antibiotic plus T-H and 44.6% with T-H alone. A total of 55.3% of the sealings were performed in peritonitis caused by coagulase-negative staphylococci, 65.4% of which were sealed with T-H or antibiotic plus T-H (Table 1).

Two of the peritonitis relapsed with conventional treatment (unsealed or sealed with antibiotic) and, after sealing the peritoneal catheter with T-H, no recurrence was observed.

The catheter was removed from a patient with peritonitis plus S. aureus tunnelitis, a new catheter was placed deferred, but he had a new episode of peritonitis with S. aureus tunnelitis and the catheter was removed again; this patient's case is special as he has not maintained adequate hygiene measures in addition to lack of adherence to therapy.

Conclusion

Peritoneal catheter sealing, especially with T-H, appears to be effective in the treatment and prevention of relapsing peritonitis. In our case, we did not observe any recurrent peritonitis after its use.

Despite its widespread use, there are hardly any studies on its use and the most recommendable guidelines for its use, which is why we believe that further studies should be conducted to establish guidelines and methods for its use.