Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Peritonitis in Children Undergoing Peritoneal Dialysis: 10 Years' Experience in a Single Center

소아 복막 투석 환자에서 발생한 복막염: 단일기관에서 10년간의 경험

  • Lee, Se-Eun (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Han, Kyoung-Hee (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Jung, Yun-Hye (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Hyun-Kyung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kang, Hee-Gyung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Cheong, Hae-Il (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Ha, Il-Soo (Department of Pediatrics, Seoul National University College of Medicine)
  • 이세은 (서울대학교 의과대학 소아과학교실) ;
  • 한경희 (서울대학교 의과대학 소아과학교실) ;
  • 정윤혜 (서울대학교 의과대학 소아과학교실) ;
  • 이현경 (서울대학교 의과대학 소아과학교실) ;
  • 강희경 (서울대학교 의과대학 소아과학교실) ;
  • 정해일 (서울대학교 의과대학 소아과학교실) ;
  • 하일수 (서울대학교 의과대학 소아과학교실)
  • Received : 2010.09.18
  • Accepted : 2010.10.11
  • Published : 2010.10.31
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Abstract

Purpose : The organisms causing peritonitis and their antibiotic sensitivities vary in different regions and centers, and these data are necessary to establish regional treatment guidelines. The aim of this study was to investigate the changes in incidence and characteristics of the organisms that cause peritonitis in children undergoing peritoneal dialysis (PD) during recent 10 years. Methods : We retrospectively collected and analyzed the data from medical records of 110 children on PD during the period from 2000 to 2010. Results : One hundred and forty episodes of peritonitis have occurred in 57 patients. The overall incidence of peritonitis was 0.43 episodes/patient year, and similar incidence have been maintained since 2003. Sixty percent of the patients experienced peritonitis within 1 year of PD, and all patients commencing PD in infancy experienced peritonitis. Gram positive (G (+)), gram negative (G (-)) organisms and fungi were cultured in 58%, 38%, and 4.1% respectively and cultures were negative in 13.6%. Staphylococcus was the most common G (+) organism, and Pseudomonas and Acinetobacter were 2 most frequent G (-) organisms isolated. Fifty-six percent of the G (+) organisms were sensitive to first generation cephalosporin and 91% of G (-) pathogens were sensitive to ceftazidime. Methicillin-resistance rate was not higher in children less than 2 years of age than in those more than 2 years. Conclusion : An additional breakthrough has to be made to further reduce the incidence of peritonitis. Treatment guideline customized for peritonitis in Korean children on PD need to be established through a nationwide co-work.

목 적 : 복막염의 원인균과 항생제 감수성은 지역이나 병원에 따라 다양하다. 따라서 이에 대한 자료가 치료 지침의 수립에 반드시 필요하다. 본 연구는 최근 10년동안 복막 투석을 받은 소아 환자들에서 발생한 복막염의 발생 빈도와 원인균의 특성의 변화를 알아보기 위해 수행되었다. 방 법 : 2000년부터 2010년까지 서울대학교 어린이병원에서 복막 투석을 받은 110명의 소아 환자들을 대상으로 하여 의무기록을 후향적으로 분석하였다. 결 과 : 복막 투석을 받은 환자 110명 중 57명에서 140례의 복막염이 발생하였다. 복막염의 발생 빈도는 0.43회/환자 년이었고, 2003년 이후로는 비슷한 빈도로 발생하고 있다. 60%의 환자가 복막 투석 시작 후 첫 1년 이내에 복막염이 발생하였고, 1세 미만에 복막 투석을 시작한 환아 7명은 모두 복막염을 경험하였다. 원인균으로 그람 양성균, 그람 음성균, 진균이 각각 58%, 38%, 4.1% 였고, 배양 음성률은 13.6% 였다. 그람 양성균 중에는 Staphylococcus, 그람 음성균 중에는Pseudomonas와Acinetobacter가 가장 많이 동정되었다. 그람 양성균중 56%가에는 1세대 cephalosporin에 감수성을 보였고, 그람 음성균 중 91%가 ceftazidime에 감수성을 보였다. 결 론 : 앞으로 복막염의 빈도를 더욱 감소시키기 위한 새로운 돌파구가 필요하다. 영아에서 복막염이 더 잘 발생하였지만, methicillin에 대한 저항성은 2세 미만에서 유의하게 높지 않았다. 전국적인 공동연구를 통해 우리나라 실정에 맞는 경험적 항생제 사용 지침을 정하는 것이 필요하다고 생각된다.

Keywords

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