Peritonitis in children with nephrotic syndrome.
In a retrospective review of 300 children with nephrotic syndrome seen at National Taiwan University Hospital throughout the 12-year period from 1978 to 1990, 20 episodes of peritonitis were identified in 17 patients (7.4%). Gram-negative bacilli (E. coli and Klebsiella pneumoniae) were the majority of pathogens, accounting for 55% of all the cases. Streptococcus pneumoniae were cultured from only 15% of the patients. An additional 15% had negative culture results, but were clinically responsive to penicillin. In 15% of cases the cause was unknown. Clinically, peritonitis was characterized by abdominal pain (100%), abdominal tenderness (100%), rebounding pain (85%), leukocytosis (85%), and fever (75%). Based on this data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis, using a combination of penicillin plus either an aminoglycoside or a broad-spectrum cephalosporin. This regimen should be continued until culture results are available.
Fang
L J
LJ
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Tsau
Y K
YK
Chen
C H
CH
Lee
C Y
CY
D000293:Adolescent; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications*; D010538:Peritonitis / Q000150:complications* / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies