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[Peritonitis in pediatric patients receiving peritoneal dialysis]
Manel Jellouli1, Meriem Ferjani1, Kamel Abidi1
1Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie.
Insights
Peritonitis is a frequent complication of pediatric peritoneal dialysis (PD). Poor weight, non-automated PD, and short delays post-catheter insertion are key risk factors for infection. Targeted prevention strategies are crucial.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Dialysis Therapy
Background:
- Peritonitis is the most common complication of peritoneal dialysis (PD) in children, contributing significantly to morbidity and mortality.
- Investigating risk factors for peritonitis is crucial for improving outcomes in pediatric PD patients.
Purpose of the Study:
- To identify independent risk factors for peritonitis in pediatric patients undergoing peritoneal dialysis.
- To inform targeted primary prevention strategies for peritonitis in this population.
Main Methods:
- Retrospective collection of medical records from 85 pediatric patients treated with PD over ten years.
- Analysis of patient data to identify correlations between various factors and peritonitis incidence.
Main Results:
- The peritonitis rate was 0.75 episodes per patient-year, with Gram-positive organisms being more common.
- Significant independent risk factors identified: poor weight, non-automated PD, and short delay from catheter insertion to PD initiation.
- Early-onset peritonitis correlated with more frequent episodes; Gram-negative peritonitis linked to ureterostomy, and Gram-positive peritonitis to exit-site/tunnel infections.
Conclusions:
- A significant incidence of peritonitis necessitates targeted primary prevention strategies.
- Nutritional support is vital to address poor weight as a risk factor.
- Automated PD is recommended as the preferred modality to reduce peritonitis risk.
Background:
Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children.
Methods:
In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis.
Results:
Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis.
Conclusion:
Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.
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