Questions About PD
It is indeed likely there is a biofilm on the catheter. Except from catheter removal, there are currently no high-level evidence about the optimal treatment for such situation.
For refractory or relapsing cases of coagulase-negative staphylococcus PD-associated peritonitis, we use a protocol combining intraperitoneal instillation of urokinase and antibiotherapy, which increases the rate of catheter salvage (Demoulin et al, Perit Dial Int 2009).
Our experience with such organisms is more limited but we would consider this protocol as a reasonable alternative, provided antibiotics are adapted, the patient has no contraindication to urokinase, and he is well-informed the procedure constitutes an alternative to existing guidelines but is not based on large clinical trials (because of his request not to remove the peritoneal catheter).