Dr Jack Rycen1, Dr Sofia Santagada2, Dr Vikas Srivastava2
1Princess Alexandra Hospital, Brisbane, Australia, 2Townsville University Hospital, Townsville, Australia
Biography:
Dr Jack Rycen is a Nephrology Advanced Trainee in his second year of training at the Princess Alexandra Hospital and Queensland Kidney and Transplant Service.
Background:
Coagulase-negative Staphylococci are a common cause of relapsing PD peritonitis and can be challenging to manage due to colonisation of the PD catheter with biofilm. Taurolidine catheter-locking solution (Taurolock) has been shown to prevent formation of bacterial biofilms in vascular catheters used for haemodialysis. We present the use of Taurolock to salvage a PD catheter for a geographically isolated patient in remote North Queensland.
Case report:
An 81-year-old man established on automated PD (APD) presented to his nearest rural hospital with his first episode of PD peritonitis. PD effluent cultured Staphylococcus epidermidis and he received 14 days of intraperitoneal (IP) cefazolin according to statewide guidelines. Following discharge, his technique was reviewed by a PD-trained nurse and deemed adequate. Twelve days later, he re-presented with turbid effluent and culture confirmed relapsing PD peritonitis with S. epidermidis. Based on culture sensitivities, he received 21 days of twice weekly IP vancomycin. After a third presentation 27 days later with relapsing peritonitis due to S. epidermidis, he was transferred to a tertiary centre to consider PD catheter removal, given suspicion of biofilm formation. Following a literature review and shared decision-making, a trial of Taurolock instilled directly into the PD catheter was undertaken in an attempt to eradicate the suspected biofilm. After 5 days of observed daily instillation, the patient returned home and completed 4 weeks of twice weekly Taurolock. Post-treatment effluent cultures were negative, and no serious adverse effects or subsequent episodes of peritonitis were reported.
Conclusion:
Taurolock may be a useful adjunct in the management of selected patients with relapsing or repeat PD peritonitis where biofilm is suspected, and catheter removal is undesirable.