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Comparison of peritoneal fluid culture results from adults and children undergoing CAPD
1Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel.
Insights
Peritonitis is more frequent in children on continuous ambulatory peritoneal dialysis (CAPD). Significant differences in microbes and antibiotic susceptibilities exist between pediatric and adult CAPD patients, informing empirical treatment strategies.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a frequent complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), particularly those with end-stage renal disease.
- Empirical treatment relies on understanding common pathogens and their antibiotic susceptibilities.
Purpose of the Study:
- To compare microbial causes and antimicrobial susceptibilities of peritoneal fluid cultures in adult and pediatric CAPD patients.
- To identify differences in peritonitis incidence and causative organisms between age groups.
Main Methods:
- A three-year retrospective analysis of peritoneal fluid cultures from adult and pediatric CAPD patients.
- Comparison of microbial isolates and their antibiotic susceptibility patterns between the two age groups.
Main Results:
- Children experienced significantly more peritonitis episodes and a higher number of microbial isolates per patient compared to adults.
- Staphylococcus aureus was more prevalent in adult peritonitis episodes, while Pseudomonas and Candida (especially Candida parapsilosis) were more common in children.
- Significant differences in antimicrobial susceptibilities to several antibiotics were observed between pediatric and adult CAPD patients.
Conclusions:
- Continuous ambulatory peritoneal dialysis-associated peritonitis occurs more frequently in children than adults.
- Distinct microbial etiologies and antimicrobial susceptibility profiles necessitate tailored empirical treatment approaches for pediatric and adult CAPD patients.
- Regular analysis of peritoneal fluid culture data within dialysis units is crucial for optimizing peritonitis management.
Background:
Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities.
Objective:
To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities.
Design:
Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD.
Results:
We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2+/-3.5, range 1 - 15) compared to 187 in adults (2.1+/-1.9, range 1 - 10) (p< 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) (p < 0.001).The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8+/-2.3, range 1 - 12; and 5.3+/-5.2, range 1 - 27) than in adults (2.0+/-1.3, range 1 - 6; and 2.7+/-2.4, range 1 - 10) (p< 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children (p< 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults (p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children (p< 0.01), whereas S. aureus occurred more often in adults (p< 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults (p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults (p< 0.05 - 0.001).
Conclusions:
CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
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