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Universal Exit-Site Antibiotic Prophylaxis Reduces Exit-Site Infections in Pediatric Peritoneal Dialysis
Eugene Yu-Hin Chan1,2, Dongyang Zhou1, Chloe Wing-Yan Siu3
1Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
Insights
Implementing daily exit-site antibiotic prophylaxis in children on peritoneal dialysis (PD) significantly reduces exit-site and tunnel infections (ESI/TI). This intervention also leads to shorter hospital stays for pediatric PD patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Limited data exists on the efficacy of exit-site antibiotic prophylaxis in pediatric peritoneal dialysis (PD).
- Infections are a significant complication in children undergoing chronic PD.
Purpose of the Study:
- To evaluate the impact of universal exit-site antibiotic prophylaxis on infection rates in pediatric PD patients.
- To assess changes in exit-site infection (ESI), tunnel infection (TI), and peritonitis rates.
Main Methods:
- Prospective observational cohort study of pediatric patients (<21 years) on chronic PD.
- Compared infection rates 2 years before (preprophylaxis) and 3 years after (postprophylaxis) implementing prophylaxis.
- Monitored annualized rates of ESI, TI, and peritonitis.
Main Results:
- The postprophylaxis group showed a significantly lower annualized ESI or TI rate (0.17 vs. 0.46 episodes/patient-year).
- Gram-positive ESI/TI rates decreased significantly (0.35 to 0.10 episodes/patient-year).
- Hospitalization days due to PD-related infections were significantly reduced in the postprophylaxis group (2.08 vs. 4.22 days/patient-year).
Conclusions:
- Daily exit-site antibiotic prophylaxis is effective in preventing gram-positive ESI/TI in children on PD.
- This prophylaxis strategy shortens hospital stays related to PD infections.
- Universal prophylaxis should be considered for pediatric PD patients.
Introduction:
Data on exit-site antibiotic prophylaxis in children undergoing peritoneal dialysis (PD) is scarce.
Methods:
We conducted a prospective observational cohort study of pediatric patients (aged < 21 years) who received chronic PD 2 years before (preprophylaxis) and/or 3 years after (postprophylaxis) implementing universal exit-site antibiotic prophylaxis. Catheter and exit-site care remained unchanged. The primary outcomes were annualized rates of exit-site infection (ESI), tunnel infection (TI), and peritonitis.
Results:
Fifty-seven children (32 girls; 15.1 years, interquartile range: 9.2-17.2) were included. All, except 2 patients underwent automated PD. Thirty-nine and 42 subjects, respectively, received PD during the preprophylaxis and postprophylaxis periods with comparable clinical characteristics. The observation period was 110.0 patient-years. Thirty-seven and 5 patients from the postprophylaxis period received mupirocin and gentamicin, respectively. The annualized ESI or TI rate was significantly lower in the postprophylaxis group (0.17, 95% confidence interval [CI]: 0.07-0.30 vs. 0.46, 95% CI: 0.29-0.68 episodes/patient-yrs; P = 0.003; incidence rate ratio: 0.34, 95% CI: 0.14-0.76; P = 0.004). Annualized rates of gram-positive ESI or TI reduced from 0.35 (95% CI: 0.20-0.54) to 0.10 (95% CI: 0.04-0.23) episodes/patient-yrs (P = 0.007); gram-negative, fungal, and culture-negative ESI or TI rates were similar. Only four peritonitis episodes were reported, with no significant difference between groups. Five catheters were removed in 3 patients because of PD-related infections. Hospitalization days due to PD-related infection were significantly lower in the postprophylaxis group (2.08, 95% CI: 1.72-2.49, vs. 4.22, 95% CI: 3.68-4.81 days/patient-yrs; incidence rate ratio: 0.49, 95% CI: 0.39-0.62; P < 0.001).
Conclusion:
Daily exit-site antibiotic prophylaxis prevents gram-positive ESI or TI and shortens hospital stays in children undergoing PD.
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