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Prevention of peritonitis in children on peritoneal dialysis
E Verrina1, M Honda, B A Warady
1G. Gaslini Children's Hospital, Genoa, Italy.
Insights
Preventing peritonitis in children involves using double-cuffed catheters and experienced surgeons. Strategies like mupirocin, avoiding spiking, and antibiotic prophylaxis can further reduce infection risks.
Area of Science:
- Pediatric Nephrology
- Infectious Disease Management
Background:
- Peritonitis is a significant complication in children undergoing peritoneal dialysis.
- Effective prevention strategies are crucial to minimize morbidity and treatment interruptions.
Purpose of the Study:
- To review and synthesize evidence-based methods for preventing peritonitis in pediatric patients.
- To identify key interventions that reduce the incidence of peritonitis in children.
Main Methods:
- Systematic review of existing literature on peritonitis prevention in children.
- Analysis of factors influencing peritonitis rates, including catheter type, surgical technique, and antimicrobial use.
Main Results:
- Double-cuffed catheters with downward-directed tunnels, placed by experienced surgeons, are associated with the lowest peritonitis rates.
- Mupirocin at the exit site may reduce Staphylococcus aureus infections, though pediatric evidence is limited.
- Avoiding catheter spiking, comprehensive patient training, and judicious antibiotic prophylaxis are effective preventive measures.
Conclusions:
- A multi-faceted approach combining optimal catheter placement, meticulous technique, and appropriate antimicrobial use is essential for peritonitis prevention in children.
- Simultaneous catheter removal and replacement can be considered for catheter-related peritonitis to prevent recurrence.
Abstract:
We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.