Skip to main content

Advertisement

SpringerLink
Log in

Prevention of peritonitis in children receiving peritoneal dialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Peritonitis and catheter-related (exit-site/tunnel) infections are major causes of morbidity in children receiving peritoneal dialysis (PD). Our objective was to evaluate the impact of a combination of prophylactic measures on the rate of peritonitis and catheter-related infections subsequent to their implementation in 2001. This is a single center review of incident patients who received automated peritoneal dialysis (APD) from 1997 to 2004. The causal microorganisms, annualized peritonitis and catheter-related infections rates and the time to infection were reviewed using pooled data from 1997 to 2000 and from 2001 to 2004. Fifty-four patients received PD over 1099 patient months (pm). Twenty-eight peritonitis episodes occurred in 15 patients over 599 pm from 1997 to 2000 (annualized rate (AR): 0.56 infections/patient year). Eight episodes of peritonitis occurred in five patients over 500 pm from 2001 to 2004 (AR: 0.19 infections/patient year) (P = 0.01). Prior to 2001, the median time from dialysis initiation to the first peritonitis episode was 500 days (95% CI, 400–660 days), compared to 1137 days (95% CI, 1050 to +Infinity) from 2001 to 2004 (P = 0.008). The rate of catheter-related infections and time to initial infection during the two periods was not different. We conclude that measures to decrease the frequency of peritonitis can be successfully applied to children and should be incorporated as part of standard care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Warady BA, Schaefer FS (2004) Peritonitis. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds). Pediatric Dialysis. Kluwer Academic Publishers, Great Britain; pp 393–414

    Chapter  Google Scholar 

  2. Thodis E, Passadakis P, Vargemezis V, Oreopoulos DG (2001) Prevention of catheter-related infections in patients on CAPD. Int J Artif Organs 24:671–682

    Article  CAS  Google Scholar 

  3. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper EJ, Li PK, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L, ISPD Ad Hoc Advisory Committee (2005) Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 25:107–131

    PubMed  Google Scholar 

  4. Verrina E, Honda M, Warady BA, Piraino B (2000) Prevention of peritonitis in children on peritoneal dialysis. Perit Dial Int 20:625–630

    CAS  PubMed  Google Scholar 

  5. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report (https://doi.org/www.naprtcs.org)

  6. Vas S, Oreopoulos DG (2001) Infections in patients undergoing peritoneal dialysis. Infect Dis Clin North Am 15:743–774

    Article  CAS  Google Scholar 

  7. Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M, Mujais S, Verrina E, International society for peritoneal dialysis (ISPD) Advisory Committee on Peritonitis Management in Pediatric Patients (2000) Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20:610–624

    CAS  Google Scholar 

  8. Piraino B (2000) Peritoneal infections. Adv Ren Replace Ther 7:280–288

    Article  CAS  Google Scholar 

  9. Twardowski ZJ, Prowant BF (1997) Current approach to exit-site infections in patients on peritoneal dialysis. Nephrol Dial Transplant 12:1284–1295

    Article  CAS  Google Scholar 

  10. Therneau TM, Grambsch PM (2000) Modeling survival data. Extending the Cox model. Springer-Verlag, New York, USA. pp 13–17 and 39–78

    Book  Google Scholar 

  11. Development Core Team (2004) A language and environment for statistical computing, Foundation for Statistical Computing, Vienna, Austria

  12. U.S. Renal Data System (USRDS 2005) Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

  13. Honda M (2002) The Japanese national registry data in pediatric PD patients in 2001. Proc Pediatric PD Conf 16:44--49

    Google Scholar 

  14. Furth SL, Donaldson LA, Sullivan EK, Watkins SL (2000) Peritoneal dialysis catheter infections and peritonitis in children: A report of the North American pediatric renal transplant cooperative study. Pediatr Nephrol 15:179–182

    Article  CAS  Google Scholar 

  15. Twardowski ZJ, Dobbie JW, Moore HL, Nichols WK, DeSpain JD, Anderson PC, Khanna R, Nolph KD, Loy TS (1991) Morphology of peritoneal dialysis catheter tunnel: macroscopy and light microscopy. Perit Dial Int 11:237–251

    CAS  PubMed  Google Scholar 

  16. Jones LL, Tweedy L, Warady BA (1995) The impact of exit-site care and catheter design on the incidence of catheter-related infections. Adv Perit Dial 11:302–305

    CAS  PubMed  Google Scholar 

  17. Chadha V, Jones LL, Ramirez ZD, Warady BA (2000) Chest wall peritoneal dialysis catheter placement in infants with a colostomy. Adv Perit Dial 16:318–320

    CAS  Google Scholar 

  18. Warchol S, Ziolkowska H, Roszkowska-Blaim M (2003) Exit-site infection in children on peritoneal dialysis: comparison of two types of peritoneal catheters. Perit Dial Int 23:169–173

    PubMed  Google Scholar 

  19. Sardegna KM, Beck AM, Strife CF (1998) Evaluation of perioperative antibiotics at the time of dialysis catheter placement. Pediatr Nephrol 12:149–152

    Article  CAS  Google Scholar 

  20. Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC (2004) Antimicrobial agents to prevent peritonitis in peritoneal dialysis: a systematic review of randomized controlled trials. Am J Kidney Dis 44:591–603

    Article  CAS  Google Scholar 

  21. Lerner GR, Warady BA, Sullivan EK, Alexander SR (1999) Chronic dialysis in children and adolescents. The 1996 annual report of the North American pediatric renal transplant cooperative study. Pediatr Nephrol 13:404–417

    Article  CAS  Google Scholar 

  22. Keane WF, Bailie GR, Boeschoten E, Gokal R, Golper TA, Holmes CJ, Kawaguchi Y, Piraino B, Riella M, Vas S; International Society for Peritoneal Dialysis (2000) International society for peritoneal dialysis. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 20:396–411

    CAS  PubMed  Google Scholar 

  23. Katyal A, Mahale A, Khanna R (2002) Antibiotic prophylaxis before peritoneal dialysis catheter insertion. Adv Perit Dial 18:112–115

    CAS  PubMed  Google Scholar 

  24. Gadallah MF, Ramdeen G, Mignone J, Patel D, Mitchell L, Tatro S (2000) Role of preoperative antibiotic prophylaxis in preventing postoperative peritonitis in newly placed peritoneal dialysis catheters. Am J Kidney Dis 36:1014–1019

    Article  CAS  Google Scholar 

  25. Sojo ET, Grosman MD, Monteverde ML, Bailez MM, Delgado N (2004) Fibrin glue is useful in preventing early dialysate leakage in children on chronic peritoneal dialysis. Perit Dial Int 24:186–190

    CAS  PubMed  Google Scholar 

  26. Rusthoven E, van de Kar NA, Monnens LA, Schroder CH (2004) Fibrin glue used successfully in peritoneal dialysis catheter leakage in children. Perit Dial Int 24:287–289

    CAS  PubMed  Google Scholar 

  27. Ritzau J, Hoffman RM, Tzamaloukas AH (2001) Effect of preventing Staphylococcus aureus carriage on rates of peritoneal catheter-related staphylococcal infections. Literature synthesis. Perit Dial Int 21:471–479

    CAS  PubMed  Google Scholar 

  28. Mupirocin Study Group (1996) Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. J Am Soc Nephrol 11:2403–2408

    Google Scholar 

  29. Wong SH, Chu KH, Cheuk A, Tsang WK, Fung SKS, Chan HWH, Tong MKL (2003) Prophylaxis against gram-positive organisms causing exit-site infection and peritonitis in continuous ambulatory peritoneal dialysis patients by applying mupirocin ointment at the catheter exit site. Perit Dial Int 23:153–158

    Google Scholar 

  30. Tacconelli E, Carmeli Y, Aizer A, Ferreira G, Foreman MG, D'Agata EM (2003) Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 37:1629–1638

    Article  CAS  Google Scholar 

  31. Piraino B, Bernardini J, Florio T, Fried L (2003) Staphylococcus aureus prophylaxis and trends in gram-negative infections in peritoneal dialysis patients. Perit Dial Int 23:456–459

    PubMed  Google Scholar 

  32. Boehm M, Vecsei A, Aufricht C, Mueller T, Csaicsich D, Arbeiter K (2005) Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study. Pediatr Nephrol 20:1478–1483

    Article  Google Scholar 

  33. Bernardini J, Bender F, Florio T, Sloand J, PalmMontalbano L, Fried L, Piraino B (2005) Randomized double blinded trial of antibiotic exit site cream for the prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol 16:539–545

    Article  CAS  Google Scholar 

  34. Oh J, Von Baum H, Klaus G, Schaefer F (2000) Nasal carriage of Staphylococcus aureus in families of children on peritoneal dialysis. Adv Perit Dial 16:324–327

    CAS  PubMed  Google Scholar 

  35. Hoshii S, Wada N, Honda M (2006) Japanese study group of pediatric peritoneal dialysis. A survey of peritonitis and exit-site and/or tunnel infections in Japanese children on PD. Pediatr Nephrol 21:828–834

    Article  Google Scholar 

  36. Amato D, de Jesus Ventura M, Miranda G, Leanos B, Alcantara G, Hurtado ME, Paniagua R (2001) Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: colonization with identical strains at exit site, nose, and hands. Am J Kidney Dis 37:43–48

    Article  CAS  Google Scholar 

  37. Holloway M, Mujais S, Kandert M, Warady BA (2001) Pediatric peritoneal dialysis training: Characteristics and impact on peritonitis rates. Perit Dial Int 21:401–404

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Pediatric Nephrology, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Ari Auron, Linda Jones, Shirley Johnson, Gulam Musharaf & Bradley A. Warady

  2. Medical Research, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Steve Simon

  3. Surgery, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Walter Andrews

Authors
  1. Ari Auron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steve Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Walter Andrews
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shirley Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gulam Musharaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bradley A. Warady
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradley A. Warady.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Auron, A., Simon, S., Andrews, W. et al. Prevention of peritonitis in children receiving peritoneal dialysis. Pediatr Nephrol 22, 578–585 (2007). https://doi.org/10.1007/s00467-006-0375-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-006-0375-0

Keywords

Search

Navigation