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Questions about PD? Ask!


from oklahoma asked on June 25, 2014:

I have a patient with tunnel infection with staph aureus. She presented with fever and pain along the tunnel and exit site redness. US showed inflammation and small fluid collection along the tunnel. It was aspirated and grew staph aureus. The PD fluid is clean. I started IP vanco and PO keflex 500 TID. Its now the 3rd day, fever is gone but still complaining of pain and drainage. Should I get the catheter removed and abondon tyring to salvage the catheter ?
Also this Pt was letting her dog sleep with her duirng nightly CCPD. Are their any recommendations about that ?


expert, MD from South America ():
We do not recommend that pets go into patients´ rooms as there are many reports of peritonitis in PD patients caused by pets. Tunnel infections usually require antibiotic treatment for 2.3 weeks, but each case may be different.

, from Europe ():
Since there was some improvement after 3 days I recommend to continue antibiotic treatment (provided that this patient does not have simultaneous peritonitis! If the latter is the case the catheter has to be removed!). A tunnel sonography would be helpful. If there is no improvement after 10-14 days of antibiotic treatemnnt catheter removal should be considered. If there is improvement, antibiotic therapy could be continued (duration of therapy in case of tunnel infection should be at least 4 weeks!).

I am not sure if dogs usually transfer S. aureus to human PD patients. However, we had 3 cases of Pasteurella multocida peritonitis (a germ which is found in the saliva of cats and dogs, you can also find some publications focusing on this problem). In all 3 cases a cat of the patient slept in the bed or even on the heater bag of the cycler (!). Especially cats like to play with the lines of the cycler (and they also may bit into the lines). This problem may be less important with dogs. Anyway, we do not recommend that animals sleep in the bed during cycler therapy (ideally, they should be out of the sleeping room).

Disclaimer: The answers represent personal views of the experts. The readers should use their own discretion in interpretation and application of the answers and the ISPD does not hold liability for such usage.

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