Prevention and treatment of peritoneal dialysis-associated peritonitis in pediatric patients

Area of Science:

• Pediatric Nephrology
• Infectious Diseases

Background:

• Peritoneal dialysis (PD) is the primary renal replacement therapy for children under 15.
• Peritonitis remains a significant complication and cause for PD program discontinuation.
• Recent trends show a decrease in PD-associated peritonitis incidence.

Purpose of the Study:

• To review the current landscape of PD-associated peritonitis in pediatric patients.
• To discuss the changing microbial patterns and contributing factors to peritonitis incidence.
• To evaluate established and emerging treatment guidelines for pediatric PD peritonitis.

Main Methods:

• Analysis of trends in PD-associated peritonitis incidence and causative organisms.
• Review of factors contributing to the decline in infectious complications.
• Assessment of current empiric antibiotic treatment strategies based on pediatric guidelines.

Main Results:

• A decline in PD-associated peritonitis incidence is observed, attributed to enhanced patient care, increased use of automated PD (APD), improved catheter design, and Staphylococcus aureus prophylaxis.
• Gram-positive organisms remain predominant, but a relative increase in gram-negative peritonitis is noted.
• Current pediatric guidelines recommend risk-stratified empiric antibiotic therapy, often involving cephalosporins or glycopeptides.

Conclusions:

• Despite a decrease in overall peritonitis rates, vigilance for gram-negative infections is crucial.
• Adherence to improved care practices and prophylactic measures is key to reducing PD-associated peritonitis.
• Ongoing evaluation of treatment regimens, such as those in the International Pediatric Peritonitis Registry, is essential for optimizing pediatric PD care.