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Peritonitis in children undergoing continuous ambulatory peritoneal dialysis
Insights
Peritonitis is a common complication in children on continuous ambulatory peritoneal dialysis (CAPD), with Staphylococcus and fungi being frequent causes. Prompt treatment with intraperitoneal cefazolin sodium is often effective, but recurrent cases may require catheter removal.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Dialysis Therapy
Background:
- Peritonitis is a significant complication in children undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Understanding causative organisms and risk factors is crucial for effective management.
Purpose of the Study:
- To analyze the incidence, causative organisms, treatment outcomes, and complications of peritonitis in children on CAPD.
- To identify factors associated with higher peritonitis rates.
Main Methods:
- Retrospective analysis of 77 peritonitis episodes in 30 children over a four-year period.
- Microbiological cultures and analysis of treatment protocols and outcomes.
Main Results:
- The incidence of peritonitis was one episode per 6.0 patient-months.
- Common organisms included Staphylococcus epidermidis (17 episodes), Staphylococcus aureus (15 episodes), and fungi (4 episodes).
- 61% of episodes were treated at home with intraperitoneal cefazolin sodium; 11 children required catheter removal due to resistant or fungal peritonitis.
Conclusions:
- Peritonitis is a frequent concern in pediatric CAPD patients, necessitating careful aseptic technique.
- While intraperitoneal antibiotics are often successful, recurrent or fungal infections pose challenges requiring potential intervention.
- Higher peritonitis rates were observed in children with aseptic technique difficulties and hospitalized patients.
Abstract:
During a four-year period there were 77 episodes and 15 recurrences of peritonitis in 30 children treated with continuous ambulatory peritoneal dialysis for periods of one to 39 months (mean, 15.3 months). The incidence was one episode per 6.0 patient-months. Organisms cultured included Staphylococcus epidermidis (17 episodes), Staphylococcus aureus (15 episodes), and fungi (four episodes). Special culture techniques were needed to ensure a high yield of positive cultures. Peritonitis was usually treated with intraperitoneal administration of cefazolin sodium, and 61% of the episodes were treated at home. There was one death, from Candida peritonitis, and catheters were removed in 11 children because of resistant or recurrent peritonitis (eight cases) or fungal peritonitis (three cases). Peritonitis rates were highest in children who had difficulty performing bag changes aseptically but who could not be transferred to hemodialysis and in hospitalized patients.