In tunneled infection management, what factor determines whether catheter removal or reposition is considered?

• A. Immediate removal always
• B. Persistence or recurrence of infection despite systemic antibiotics
• C. Fever occurs
• D. Patient preference

Answer: (B)

When managing a tunneled PD catheter infection, the key factor is how the infection responds to systemic antibiotics. If the infection resolves with antibiotic therapy, the catheter can stay in place. If the infection persists or recurs despite adequate systemic antibiotics, removing or repositioning the catheter becomes appropriate to eliminate the infection source and prevent serious complications like peritonitis or sepsis. Fever alone isn’t the deciding factor, and patient preference doesn’t override the clinical need; removal isn’t required in every case, only when the infection fails to respond. Persistent infection can be due to biofilm on the catheter, which makes eradicating it with antibiotics difficult, hence the move to remove or reposition.