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Prevention of peritonitis in children receiving peritoneal dialysis
Ari Auron1, Steve Simon, Walter Andrews
1Section of Pediatric Nephrology, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
Insights
Implementing prophylactic measures significantly reduced peritonitis rates in children undergoing peritoneal dialysis (PD). This led to a longer time between dialysis initiation and infection, improving patient outcomes.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Dialysis Technology
Background:
- Peritonitis and catheter-related infections are significant complications in pediatric peritoneal dialysis (PD).
- These infections increase morbidity and negatively impact treatment outcomes in children.
- Implementing standardized prophylactic measures is crucial for infection control in PD patients.
Purpose of the Study:
- To evaluate the effectiveness of combined prophylactic measures in reducing peritonitis and catheter-related infections in pediatric PD patients.
- To compare infection rates and time to infection before and after the implementation of new protocols in 2001.
Main Methods:
- A single-center retrospective review of pediatric patients undergoing automated peritoneal dialysis (APD) from 1997 to 2004.
- Analysis of pooled data comparing infection rates and time to infection between two periods: 1997-2000 and 2001-2004.
- Review of causal microorganisms, annualized infection rates, and time to initial infection.
Main Results:
- A significant decrease in the annualized peritonitis rate was observed, from 0.56 infections/patient year (1997-2000) to 0.19 infections/patient year (2001-2004) (P = 0.01).
- The median time from dialysis initiation to the first peritonitis episode increased significantly from 500 days to 1137 days (P = 0.008).
- No significant difference was found in the rates or time to catheter-related infections between the two periods.
Conclusions:
- Combined prophylactic measures are highly effective in reducing peritonitis frequency in children on PD.
- These infection control strategies should be integrated into standard pediatric PD care.
- Further research may be needed to address catheter-related infections specifically.
Abstract:
Peritonitis and catheter-related (exit-site/tunnel) infections are major causes of morbidity in children receiving peritoneal dialysis (PD). Our objective was to evaluate the impact of a combination of prophylactic measures on the rate of peritonitis and catheter-related infections subsequent to their implementation in 2001. This is a single center review of incident patients who received automated peritoneal dialysis (APD) from 1997 to 2004. The causal microorganisms, annualized peritonitis and catheter-related infections rates and the time to infection were reviewed using pooled data from 1997 to 2000 and from 2001 to 2004. Fifty-four patients received PD over 1099 patient months (pm). Twenty-eight peritonitis episodes occurred in 15 patients over 599 pm from 1997 to 2000 (annualized rate (AR): 0.56 infections/patient year). Eight episodes of peritonitis occurred in five patients over 500 pm from 2001 to 2004 (AR: 0.19 infections/patient year) (P = 0.01). Prior to 2001, the median time from dialysis initiation to the first peritonitis episode was 500 days (95% CI, 400-660 days), compared to 1137 days (95% CI, 1050 to +Infinity) from 2001 to 2004 (P = 0.008). The rate of catheter-related infections and time to initial infection during the two periods was not different. We conclude that measures to decrease the frequency of peritonitis can be successfully applied to children and should be incorporated as part of standard care.
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