Peritonitis in Children Who Receive Long-Term Peritoneal Dialysis

Abstract

In children who are on chronic peritoneal dialysis, peritonitis is the primary complication compromising technique survival, and the optimal therapy of peritonitis remains uncertain. An Internet-based International Pediatric Peritonitis Registry was established in 47 pediatric centers from 14 countries to evaluate the efficacy and safety of largely opinion-based peritonitis treatment guidelines in which empiric antibiotic therapy was stratified by disease severity. Among a total of 491 episodes of nonfungal peritonitis entered into the registry, Gram-positive organisms were cultured in 44%, Gram-negative organisms were cultured in 25%, and cultures remained negative in 31% of the episodes. In vitro evaluation revealed 69% sensitivity of Grampositive organisms to a first-generation cephalosporin and 80% sensitivity of Gram-negative organisms to a third-generation cephalosporin. Neither the risk factors assumed by the guidelines nor the choice of empiric therapy was predictive of either the early treatment response or the final functional outcome of the peritonitis episodes. Overall, 89% of cases achieved full functional recovery, a portion after relapsing peritonitis (9%). These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered.

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

“…The reported prevalence of FP was 2% of all peritonitis episodes in data collected by the IPPR and 2.9% in a pediatric Dutch study (125,4). Recent data in adults reveal rates of 1.5% -5.8% (126).…”

“…More recently, the IPPR data revealed an association approaching significance (p = 0.06) between gramnegative peritonitis and the presence of a gastrostomy in children (4). A significant association between FP and gastrostomy feedings has also been reported in children receiving PD if their course was complicated by malnutrition (149).…”

“…After the publication of those guidelines, the International Pediatric Peritoneal Dialysis Registry (IPPR) was established to support evaluations of the impact of implementing the guidelines on a global basis and to collect data to serve as evidence upon which future guidelines could be based. Data generated from 501 episodes of peritonitis were collected by the IPPR and serve as a foundation for many of the recommendations made in the present publication (4,5).…”

Peritoneal dialysis and infants: further insights into a complicated relationship

“…Concerns also exist that a downward exit site may be a risk factor for infections in small children using diapers. The proximity of the catheter exit site to the diaper region or to gastrostomy/vesicostomy/ nephrostomy sites has been associated with higher incidence of Gram-negative peritonitis (diaper peritonitis) compared with older children [17]. In some centers, this issue has been successfully addressed by placing the exit site outside the diaper area, in the presternal area [18].…”

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

“…Apesar dos avanços tecnológicos e da melhoria dos cuidados de assepsia do cateter de DP, as peritonites continuam a ser a complicação mais comum em crianças em DP, sendo uma causa importante de morbilidade, hospitalização e falência da técnica. 2,25,26 Tendo em conta que infeções recorrentes e graves podem resultar num comprometimento da função da membrana dialítica e fibrose peritoneal, deve ser instituído tratamento precoce e implementar medidas que promovam a sua prevenção, reforçando o ensino aos pais/cuidadores sobre cuidados de assepsia com o caté-ter. 25,26 Em relação às complicações relacionadas com a DRCT, a mais frequente foi a anemia crónica, presente em todas as crianças da amostra.…”