Abstract: 【Abstract】Objective To evaluate the effect of systemic antibiotics therapy combined with blocking dialysis catheters with low concentration of povidone-iodine (PVP-I) on refractory peritoneal dialysis (PD)-related peritonitis. Methods We retrospectively analyzed 7 patients with refractory PD-related peritonitis treated in the recent 2 years. Their dialysis catheters were planned to take off according to the latest ISPD recommendations, but they refused to do this. In addition to systemic antibiotics therapy, low concentration of PVP-I (1:1 of PVP-I and normal saline, 10ml) was gradually injected into the external short tube to block the catheter after infusion of 2000ml of peritoneal dialysate. After 30 minutes, the infused dialysate was drained out, and the external short tube was changed. This manipulation performed every other day for 3 times but without change of the external short tube anymore. The systemic antibiotics therapy lasted 14～21 days. Results Bacterial culture for peritoneal dialysate was positive in 6 of the 7 patients (85.71%). The bacteria detected included E. coli 3 cases, Gemella mobillorum one case, staphylococcus aureus one case and staphylococcus epidermidis one case. After the treatment for 4 days, bacterial culture became negative in 5 cases. After the treatment for one week, WBC in peritoneal dialysate [5.64 (2.18, 2.05)×109/L vs. 0.25 (0.20, 0.29)×109/L, Z=-2.666, P=0.008], WBC in blood [10.50 (9.73, 13.82)×109/L vs. 6.82 (5.69, 10.72)×109/L, Z=-2.108, P=0.035], neutrophil percentage [89.90 (77.20, 92.50)% vs. 69.80 (62.10, 85.70)% , Z=- 2.108, P=0.035] and CRP [85.30 (65.22, 105.89)mg/L vs. 34.30 (31.36, 46.65)mg/L, Z=-2.364, P=0.018] decreased significantly. At the end of the treatment, the peritonitis cured and the patients discharged from the hospital in 5 cases, and the catheters had to be taken off in 2 cases. Conclusion Systemic antibiotics therapy combined with low concentrations of PVP-I to block the catheters was effective for the treatment of refractory PD-related peritonitis. This treatment protocol is especially useful for the patients living far from big cities, in underdeveloped areas or unavailable access to hemodialysis.

Key words: Peritoneal dialysis,  Refractory peritoneal dialysis-related peritonitis, Blocking catheter with povidone-iodine, Treatment