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Exit-site infection during continuous and cycling peritoneal dialysis in children
1Division of Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric patients on peritoneal dialysis experienced frequent exit-site infections (ESI), often caused by Staphylococcus aureus. Associated skin infections increased ESI risk, but catheter replacement did not reduce recurrence.
Area of Science:
- Nephrology
- Pediatric Infectious Diseases
Background:
- Peritoneal dialysis (PD) is a vital treatment for pediatric end-stage renal disease.
- Exit-site infection (ESI) is a common complication of PD in children, potentially leading to peritonitis.
- Understanding ESI epidemiology in pediatric PD patients is crucial for effective management.
Purpose of the Study:
- To analyze the incidence, causative organisms, and risk factors of exit-site infections in pediatric patients undergoing peritoneal dialysis.
- To investigate the relationship between ESI and peritonitis in this population.
- To evaluate the impact of catheter replacement on ESI recurrence.
Main Methods:
- A 10-year retrospective review of pediatric patients on PD.
- Analysis of 132 episodes of exit-site infection (ESI) in 50 out of 83 patients.
- Identification of microbial causes and assessment of associated factors and outcomes.
Main Results:
- Fifty of 83 pediatric PD patients had 132 ESIs; 39 were purulent.
- Staphylococcus aureus was the most common pathogen, followed by Staphylococcus epidermidis (often in purulent infections).
- Gram-negative organisms, notably Pseudomonas species, caused 23 ESIs. Associated skin infections increased ESI risk (40%).
- Thirty-eight ESIs led to peritonitis, primarily caused by Staphylococcus and Pseudomonas species.
- Catheter replacement in 13 patients with peritonitis did not alter ESI incidence.
Conclusions:
- Staphylococcus aureus is the predominant pathogen in pediatric PD-related ESIs.
- Concurrent skin infections are a significant risk factor for ESI.
- Peritonitis is a serious complication of ESI, and catheter replacement shows no benefit in preventing recurrent ESIs.
Abstract:
A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gram-negative organisms were responsible for 23 ESIs, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.