Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Peritoneal Dialysis-related Peritonitis in Children: A Single Center's Experience Over 12 Years

소아 복막 투석 환자에서 발생한 복막염 : 단일기관에서 12년간의 경험

  • Oh, Seong Hee (Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Yoon Jung (Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Jina (Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Joo Hoon (Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine) ;
  • Park, Young Seo (Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine)
  • 오성희 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아청소년과) ;
  • 이윤정 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아청소년과) ;
  • 이진아 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아청소년과) ;
  • 이주훈 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아청소년과) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아청소년과)
  • Received : 2012.09.09
  • Accepted : 2012.10.17
  • Published : 2012.10.31
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Abstract

Purpose: The aim of our study was to investigate the characteristics of the peritoneal dialysis (PD) - related peritonitis and to evaluate the effectiveness of the empirical antibiotics recommended by the International Society for Peritoneal Dialysis in Korean children. Methods: We retrospectively reviewed the medical records of 72 children on peritoneal dialysis at the Department of Pediatrics, Asan Medical Center over the period from March 2000 to February 2012. Results: Seventy-nine episodes of peritonitis occurred in 32 patients. The incidence of peritonitis was 0.43 episodes/patient year. There were no significant differences in the incidence of peritonitis in terms of dialysis modality (P=0.459). Twenty-one patients experienced 51 catheter exit-site infections (0.28 episode/patient year). There were no significant differences in the incidence of peritonitis between those with and without history of exit-site infections (P=0.721). Specific pathogens were isolated from 68.4% (54/79) of the patient with peritonitis episodes, including Gram-positive bacteria (n=34), Gram-negative bacteria (n=25) and fungus (n=1). Among Gram-positive bacteria, 85.3% of the isolates were susceptible to ${\beta}$-lactam antibiotics, among Gram-negative rods, 94.7% of the isolates were susceptible to ceftazidime. Among 25 cases with unknown etiologies, 92.0% of cases demonstrated satisfactory responses to cefazolin and ceftazidime. Conclusions: The incidence of peritonitis was 0.43 episodes/patient year. Initial empirical therapy consisting of cefazolin and ceftazidime was appropriate for 91.1% of the PD-related peritonitis treatment. Continuous monitoring for the emergence of the resistant organisms is an important part of the appropriate managements of PD-related peritonitis.

목적: 소아 복막 투석 환자에서 복막염의 특징과 International Society for Peritoneal dialysis의 가이드라인에 따른 경험적 항생제 치료가 적절한지 분석하였다. 방법: 2000년 3월부터 2012년 2월까지 서울아산병원 소아과에서 복막 투석을 한 경험이 있는 72명의 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 결과: 복막 투석을 받은 32명의 환자에서 79회의 복막염이 발생하여 발생빈도는 0.43회/환자 년이었고 복막 투석 방식에 따른 복막염의 발생 빈도는 차이가 없었다(P=0.459). 또한 21명의 환자가 51회의 복막 도관 감염을 경험하였고 도관 감염의 발생 빈도는 0.28회/환자 년이었다. 복막 도관 감염에 따른 복막염의 발생 빈도는 차이가 없었다(P=0.721). 79회의 복막염 중 68.4%에서 균이 동정되었으며, 그람 양성균 중 85.3%가 ${\beta}$-lactam계 항생제에 감수성이 있었고 그람 음성 막대균 중 94.7%가 ceftazidime에 감수성이 있었다. 균이 동정되지 않은 복막염 중에는 92.0%에서 cefazolin과 ceftazidme에 치료 반응을 보였다. 결론: 복막 투석 환자에서 복막염의 발생 빈도는 0.43회/환자 년이었고, 복막염에 대한 치료로 cefazolin과 ceftazidime의 초기 경험적 항생제 투여는 복막염의 91.1%에서 적절하였다. 그러나 내성 균주에 대한 지속적인 감시가 필요하다.

Keywords

References

  1. Choi P, Nemati E, Banerjee A, Preston E, Levy J, Brown E. Peritoneal dialysis catheter removal for acute peritonitis: a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization. Am J Kidney Dis 2004;43:103-11. https://doi.org/10.1053/j.ajkd.2003.08.046
  2. Woodrow G, Turney JH, Brownjohn AM. Technique failure in peritoneal dialysis and its impact on patient survival. Perit Dial Int 1997;17:360-4.
  3. Fried LF, Bernardini J, Johnston JR, Piraino B. Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 1996;7:2176-82.
  4. Hoshii S, Wada N, Honda M. A survey of peritonitis and exitsite and/or tunnel infections in Japanese children on PD. Pediatr Nephrol 2006;21:828-34. https://doi.org/10.1007/s00467-006-0004-y
  5. North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2011 annual dialysis report. 2011; Available from: https://web.emmes.com/study/ped/annlrept/annualrept 2011.pdf.
  6. 2011 USRDS Annual data report 130-418. 2011; Available from: http://www.usrds.org/2011/pdf/v2_ch03_11.pdf.
  7. Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010;30:393-423. https://doi.org/10.3747/pdi.2010.00049
  8. Chadha V, Schaefer FS, Warady BA. Dialysis-associated peritonitis in children. Pediatr Nephrol 2010;25:425-40. https://doi.org/10.1007/s00467-008-1113-6
  9. Kiernan L, Kliger A, Gorban-Brennan N, Juergensen P, Tesin D, Vonesh E, et al. Comparison of continuous ambulatory peritoneal dialysis-related infections with different "Y-tubing" exchange systems. J Am Soc Nephrol 1995;5:1835-8.
  10. Thodis E, Passadakis P, Panagoutsos S, Bacharaki D, Euthimiadou A, Vargemezis V. The effectiveness of mupirocin preventing Staphylococcus aureus in catheter-related infections in peritoneal dialysis. Adv Perit Dial 2000;16:257-61.
  11. Thodis E, Bhaskaran S, Pasadakis P, Bargman JM, Vas SI, Oreopoulos DG. Decrease in Staphylococcus aureus exit-site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site. Perit Dial Int 1998;18:261-70.
  12. Bordador EB, Johnson DW, Henning P, Kennedy SE, McDonald SP, Burke JR, et al. Epidemiology and outcomes of peritonitis in children on peritoneal dialysis in Australasia. Pediatr Nephrol 2010;25:1739-45. https://doi.org/10.1007/s00467-010-1510-5
  13. Lee SG, Cho J, Sohn YB, Park SW, Kim SJ, Jin DK, et al. Peritoneal Dialysis Associated Peritonitis and Empirical Antibiotics Therapy in Korean Children with Chronic Renal Failure. J Korean Soc Pediatr Nephrol 2008;12:213-20. https://doi.org/10.3339/jkspn.2008.12.2.213
  14. Lee SE, Han KH, Jung YH, Lee HK, Kang HG, Cheong HI, et al. Peritonitis in Children Undergoing Peritoneal Dialysis: 10 Years' Experience in a Single Center. J Korean Soc Pediatr Nephrol 2010;14:174-83. https://doi.org/10.3339/jkspn.2010.14.2.174
  15. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, et al. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005;25:107-31.
  16. Warady BA, Feneberg R, Verrina E, Flynn JT, Muller-Wiefel DE, Besbas N, et al. Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines. J Am Soc Nephrol 2007;18:2172-9. https://doi.org/10.1681/ASN.2006101158
  17. Warchol S, Roszkowska-Blaim M, Latoszynska J, Jarmolinski T, Zachwieja J. Experience using presternal catheter for peritoneal dialysis in Poland: a multicenter pediatric survey. Perit Dial Int 2003;23:242-8.
  18. de Fijter CW, Oe LP, Nauta JJ, van der Meulen J, Verbrugh HA, Verhoef J, et al. Clinical efficacy and morbidity associated with continuous cyclic compared with continuous ambulatory peritoneal dialysis. Ann Intern Med 1994;120:264-71. https://doi.org/10.7326/0003-4819-120-4-199402150-00002
  19. Rodriguez-Carmona A, Perez Fontan M, Garcia Falcon T, Fernandez Rivera C, Valdes F. A comparative analysis on the incidence of peritonitis and exit-site infection in CAPD and automated peritoneal dialysis. Perit Dial Int 1999;19:253-8.
  20. Rabindranath KS, Adams J, Ali TZ, Daly C, Vale L, Macleod AM. Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2007;22:2991-8. https://doi.org/10.1093/ndt/gfm515
  21. Bro S, Bjorner JB, Tofte-Jensen P, Klem S, Almtoft B, Danielsen H, et al. A prospective, randomized multicenter study comparing APD and CAPD treatment. Perit Dial Int 1999;19:526-33.
  22. Yishak A, Bernardini J, Fried L, Piraino B. The outcome of peritonitis in patients on automated peritoneal dialysis. Adv Perit Dial 2001;17:205-8.
  23. Akman S, Bakkaloglu SA, Ekim M, Sever L, Noyan A, Aksu N. Peritonitis rates and common microorganisms in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Pediatr Int 2009;51:246-9. https://doi.org/10.1111/j.1442-200X.2008.02693.x
  24. Troidle LK, Gorban-Brennan N, Kliger AS, Finkelstein FO. Continuous cycler therapy, manual peritoneal dialysis therapy, and peritonitis. Adv Perit Dial 1998;14:137-41.
  25. Cnossen TT, Usvyat L, Kotanko P, van der Sande FM, Kooman JP, Carter M, et al. Comparison of outcomes on continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis: results from a USA database. Perit Dial Int 2011;31: 679-84. https://doi.org/10.3747/pdi.2010.00004
  26. Oo TN, Roberts TL, Collins AJ. A comparison of peritonitis rates from the United States Renal Data System database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis 2005;45:372-80. https://doi.org/10.1053/j.ajkd.2004.10.008
  27. Brunkhorst RR. Host defenses in APD. Semin Dial 2002;15: 414-7. https://doi.org/10.1046/j.1525-139X.2002.t01-1-00102.x
  28. Shetty AK, Nagaraj SK, Lorentz WB, Bitzan M. Peritonitis due to Neisseria mucosa in an adolescent receiving peritoneal dialysis. Infection 2005;33:390-2. https://doi.org/10.1007/s15010-005-5074-4
  29. Neu AM, Case B, Lederman HM, Fivush BA. Neisseria sicca peritonitis in a patient maintained on chronic peritoneal dialysis. Pediatr Nephrol 1994;8:601-2. https://doi.org/10.1007/BF00858142
  30. Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, et al. Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 2000;20:610-24.
  31. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 2012;32:S29-S86. https://doi.org/10.3747/pdi.2010.00300
  32. Szeto CC, Chow KM, Kwan BC, Law MC, Chung KY, Yu S, et al. Staphylococcus aureus peritonitis complicates peritoneal dialysis: review of 245 consecutive cases. Clin J Am Soc Nephrol 2007;2:245-51. https://doi.org/10.2215/CJN.03180906
  33. Govindarajulu S, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Staphylococcus aureus peritonitis in Australian peritoneal dialysis patients: predictors, treatment, and outcomes in 503 cases. Perit Dial Int 2010;30:311-9. https://doi.org/10.3747/pdi.2008.00258
  34. Ariano RE, Franczuk C, Fine A, Harding GK, Zelenitsky SA. Challenging the current treatment paradigm for methicillinresistant Staphylococcus epidermidis peritonitis in peritoneal dialysis patients. Perit Dial Int 2002;22:335-8.
  35. Goldberg L, Clemenger M, Azadian B, Brown EA. Initial treatment of peritoneal dialysis peritonitis without vancomycin with a once-daily cefazolin-based regimen. Am J Kidney Dis 2001;37:49-55. https://doi.org/10.1053/ajkd.2001.20581
  36. Golper T. Intermittent versus continuous antibiotics for PDrelated peritonitis. Perit Dial Int 1997;17:11-2.
  37. Siva B, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Pseudomonas peritonitis in Australia: predictors, treatment, and outcomes in 191 cases. Clin J Am Soc Nephrol 2009;4:957-64. https://doi.org/10.2215/CJN.00010109
  38. Fahim M, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Culture-negative peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes in 435 cases. Am J Kidney Dis 2010;55:690-7. https://doi.org/10.1053/j.ajkd.2009.11.015
  39. Furth SL, Donaldson LA, Sullivan EK, Watkins SL. Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 2000;15:179-82. https://doi.org/10.1007/s004670000441
  40. van Diepen AT, Tomlinson GA, Jassal SV. The Association between Exit Site Infection and Subsequent Peritonitis among Peritoneal Dialysis Patients. Clin J Am Soc Nephrol 2012;7:1266-71. https://doi.org/10.2215/CJN.00980112
  41. Zurowska A, Feneberg R, Warady BA, Zimmering M, Monteverde M, Testa S, et al. Gram-negative peritonitis in children undergoing long-term peritoneal dialysis. Am J Kidney Dis 2008;51:455-62. https://doi.org/10.1053/j.ajkd.2007.11.011