Peritonitis in a pediatric dialysis unit: local profile and implications

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Dialysis Therapy

Background:

• Peritonitis is a significant complication in chronic peritoneal dialysis (PD).
• Monitoring infection rates is crucial for defining local microbiological profiles.
• Establishing appropriate empiric antibiotic regimens is recommended for PD centers.

Purpose of the Study:

• To analyze the microbiological profile of peritonitis in a pediatric dialysis unit.
• To identify local predisposing factors for peritonitis in pediatric PD patients.

Main Methods:

• Retrospective review of patient files for children undergoing chronic PD from 1997-2007.
• Analysis of 80 peritonitis episodes across 29 pediatric patients over 578 patient-months.
• Statistical analysis to identify factors associated with increased peritonitis rates.

Main Results:

• The primary pathogens identified were coagulase-negative Staphylococcus (32.5%) and Pseudomonas spp. (16%).
• Pseudomonas spp. were frequently cultured from exit sites preceding peritonitis (64-69%).
• Contaminating conditions (e.g., gastrostomy, enuresis, diaper use) and early infection (<6 months) were significantly associated with higher peritonitis rates (P=0.01, P=0.009).
• Children under 5 years old experienced at least one peritonitis episode; 31% of patients remained peritonitis-free.

Conclusions:

• Key risk factors for pediatric peritonitis include early treatment infection, Pseudomonas exit-site colonization, and contaminating conditions.
• Young age (<5 years) at PD initiation is a significant risk factor.
• Targeted caregiver training and close follow-up are essential for high-risk pediatric patients to prevent complications.