Abstract
Pediatric peritoneal dialysis (PD) patients are at risk for acute peritonitis. One risk factor is accidental exposure of the catheter to a non-sterile surface. We studied catheter exposures in 17 pediatric patients receiving PD who developed 16 holes and 12 other accidental exposures. The rate of exposures was 3.7 events/100 patient-months. After exposure, the mean counts (± standard error) of white blood cells (WBC), red blood cells, and neutrophils were 39.8 ± 19.3, 9.5 ± 7.1, and 24.2 ± 5.3/mm3, respectively. There was a trend towards higher peritoneal fluid WBC in patients with holes than in those with exposures (60.1 ± 34.8 vs. 15.4 ± 5.1/mm3, respectively; p = 0.2). The initial peritoneal fluid WBC count was significantly higher if there was a positive culture than a negative culture (165.0 ± 132.6 vs. 20.3 ± 6.4/mm3, respectively; p = 0.01). The percentage of neutrophils was higher in patients with a positive culture than in those with a negative culture (54.7 ± 14.1 vs. 19.1 ± 4.9%, respectively; p = 0.01). Of the 28 patients, 27 received a single dose of intravenous antibiotics, as per the protocol at that time. Among those treated, 7% developed a positive culture (all staphylococcal species) while 93% had a negative culture. We conclude that following accidental exposure of the peritoneal dialysis catheter: (1) the prevalence of peritonitis is low; (2) measuring peritoneal fluid WBC provides treatment guidance; (3) if treatment is initiated, it should be applied intraperitoneally and include activity against Gram-positive organisms.
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Silverstein, D.M., Wilcox, J.E. Outcome of accidental peritoneal dialysis catheter holes or tip exposure. Pediatr Nephrol 25, 1147–1151 (2010). https://doi.org/10.1007/s00467-010-1456-7
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DOI: https://doi.org/10.1007/s00467-010-1456-7