Peritonitis in children on continuous ambulatory peritoneal dialysis
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H Mocan1, A V Murphy, T J Beattie
1Department of Nephrology, Royal Hospital for Sick Children, Glasgow, U.K.
Abstract:
Between 1979 and 1985, 26 patients on continuous ambulatory peritoneal dialysis had 97 episodes of peritonitis. These occurred over a period of 336 patient months, giving an incidence of one episode every 3.5 patient months. The micro-organisms comprised Gram-positive and Gram-negative bacteria as well as fungi which accounted for six episodes. Gram-positive bacteria were isolated in 49 of the 97 episodes (50.5%) with Staphylococcus epidermidis predominating. The incidence of culture-negative peritonitis was high (27.8%). Because of failure to respond to treatment, or because of frequent recurrences, 42% patients were transferred to haemodialysis. The changing bacterial ecology has necessitated an alteration in choice of antibiotics. Cefamandole and/or gentamicin are no longer appropriate since 46% strains of S. epidermidis are now methicillin-resistant. Our 'best guess' choice for bacterial peritonitis would now start with netilmicin, vancomycin being added if indicated. For fungal peritonitis we would now start with a primary course of anti-fungal agents followed by early removal of the catheter if there is no response to treatment.
Insights
Peritonitis in continuous ambulatory peritoneal dialysis patients occurred frequently, with Gram-positive bacteria like Staphylococcus epidermidis being common. Antibiotic choices must adapt due to increasing methicillin-resistant Staphylococcus epidermidis strains.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a significant complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Understanding the microbial etiology and incidence of peritonitis is crucial for effective management.
- Changes in bacterial resistance patterns necessitate ongoing evaluation of treatment protocols.
Purpose of the Study:
- To analyze the incidence and microbial causes of peritonitis in CAPD patients.
- To evaluate the effectiveness of current antibiotic strategies.
- To recommend updated antibiotic regimens based on evolving bacterial resistance.
Main Methods:
- Retrospective analysis of 97 peritonitis episodes in 26 CAPD patients from 1979 to 1985.
- Microbiological culture and sensitivity testing of causative organisms.
- Assessment of treatment outcomes and patient transfer to hemodialysis.
Main Results:
- An incidence rate of one peritonitis episode per 3.5 patient months was observed.
- Gram-positive bacteria (50.5%), predominantly Staphylococcus epidermidis, were the most common pathogens.
- A high rate of culture-negative peritonitis (27.8%) and 42% of patients transferred to hemodialysis due to treatment failure or recurrence.
Conclusions:
- The study highlights a high incidence of peritonitis and a significant challenge posed by methicillin-resistant Staphylococcus epidermidis (46% of strains).
- Current antibiotic choices like cefamandole and gentamicin are inadequate.
- Recommended initial treatment for bacterial peritonitis includes netilmicin, with vancomycin added as needed; fungal peritonitis requires prompt antifungal therapy and potential catheter removal.