Yonsei Med J.  2013 Jul;54(4):983-989. 10.3349/ymj.2013.54.4.983.

Outcomes of Peritonitis in Children on Peritoneal Dialysis: A 25-Year Experience at Severance Hospital

• Lee KO
• Park SJ
• Kim JH
• Lee JS
• Kim PK
• Shin JI

• KMID: 2158235
• DOI: http://doi.org/10.3349/ymj.2013.54.4.983

Abstract

PURPOSE
Relatively little is known on the microbiology, risk factors and outcomes of peritoneal dialysis (PD)-associated peritonitis in Korean children. We performed this study in order to evaluate the incidence, treatment and clinical outcomes of peritonitis in pediatric PD patients at Severance Hospital.
MATERIALS AND METHODS
We analyzed data from 57 PD patients younger than 18 years during the period between June 1, 1986 and December 31, 2011. The collected data included gender, age at commencement of PD, age at peritonitis, incidence of peritonitis, underlying causes of end stage renal disease, microbiology of peritonitis episodes, antibiotics sensitivity, modality and outcomes of PD.
RESULTS
We found 56 episodes of peritonitis in 23 of the 57 PD patients (0.43 episodes/patient-year). Gram-positive bacteria were the most commonly isolated organisms (40 episodes, 71.4%). Peritonitis developed in 17 patients during the first 6 months following initiation of PD (73.9%). Peritonitis episodes rarely resulted in relapse or the need for permanent hemodialysis and no patient deaths were directly attributable to peritonitis. Antibiotic regimens included cefazolin+tobramycin from the years of 1986 to 2000 and cefazolin+ceftazidime from the years of 2001 to 2011. While antibiotic therapy was successful in 48 episodes (85.7%), the treatment was ineffective in 8 episodes (14.3%). The rate of continuous ambulatory PD (CAPD) peritonitis was statistically higher than that of automated PD (APD) (p=0.025).
CONCLUSION
Peritonitis was an important complication of PD therapy and we observed a higher incidence of PD peritonitis in patients with CAPD when compared to APD.

Keyword

Peritoneal dialysis; peritonitis; continuous ambulatory peritoneal dialysis; automated peritoneal dialysis; children

MeSH Terms

Adolescent
Anti-Bacterial Agents/therapeutic use
Cefazolin/therapeutic use
Ceftazidime/therapeutic use
Child
Child, Preschool
Female
Humans
Infant
Male
Peritoneal Dialysis/*adverse effects/methods
Peritoneal Dialysis, Continuous Ambulatory/*adverse effects
Peritonitis/drug therapy/epidemiology/*etiology/*microbiology
Tobramycin/therapeutic use
Treatment Outcome
Anti-Bacterial Agents
Ceftazidime
Cefazolin
Tobramycin

Figure

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  Fig. 1 Incidence of PD peritonitis every five years. PD, peritoneal dialysis.

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  Fig. 2 Comparison of peritonitis rate between CAPD and APD (total n=57). *Continuous ambulatory peritoneal dialysis. †Automated peritoneal dialysis. CAPD, continuous ambulatory PD; APD, automated PD; PD, peritoneal dialysis.

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  Fig. 3 Incidences of PD peritonitis by age. PD, peritoneal dialysis.

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