Comparison of peritoneal fluid culture results from adults and children undergoing CAPD.
BACKGROUND
Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities.


OBJECTIVE
To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities.


METHODS
Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD.


RESULTS
We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2+/-3.5, range 1 - 15) compared to 187 in adults (2.1+/-1.9, range 1 - 10) (p< 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) (p < 0.001).The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8+/-2.3, range 1 - 12; and 5.3+/-5.2, range 1 - 27) than in adults (2.0+/-1.3, range 1 - 6; and 2.7+/-2.4, range 1 - 10) (p< 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children (p< 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults (p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children (p< 0.01), whereas S. aureus occurred more often in adults (p< 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults (p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults (p< 0.05 - 0.001).


CONCLUSIONS
CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
Yinnon
A M
AM
Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel.
Gabay
D
D
Raveh
D
D
Schlesinger
Y
Y
Slotki
I
I
Attias
D
D
Rudensky
B
B
D000328:Adult; D000367:Age Factors; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology*; D001419:Bacteria / Q000145:classification* / Q000187:drug effects; D002175:Candida / Q000145:classification; D002177:Candidiasis / Q000175:diagnosis; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002701:Chloramphenicol / Q000627:therapeutic use; D015314:Dialysis Solutions / Q000032:analysis*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D010406:Penicillins / Q000627:therapeutic use; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015314:Dialysis Solutions; D005839:Gentamicins; D010406:Penicillins; D002701:Chloramphenicol; D002443:Ceftriaxone; D000667:Ampicillin