title: Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines.
abstract: In children who are on chronic peritoneal dialysis, peritonitis is the primary complication compromising technique survival, and the optimal therapy of peritonitis remains uncertain. An Internet-based International Pediatric Peritonitis Registry was established in 47 pediatric centers from 14 countries to evaluate the efficacy and safety of largely opinion-based peritonitis treatment guidelines in which empiric antibiotic therapy was stratified by disease severity. Among a total of 491 episodes of nonfungal peritonitis entered into the registry, Gram-positive organisms were cultured in 44%, Gram-negative organisms were cultured in 25%, and cultures remained negative in 31% of the episodes. In vitro evaluation revealed 69% sensitivity of Gram-positive organisms to a first-generation cephalosporin and 80% sensitivity of Gram-negative organisms to a third-generation cephalosporin. Neither the risk factors assumed by the guidelines nor the choice of empiric therapy was predictive of either the early treatment response or the final functional outcome of the peritonitis episodes. Overall, 89% of cases achieved full functional recovery, a portion after relapsing peritonitis (9%). These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered.
authors.affiliation: Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO 64108, USA. bwarady@cmh.edu
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Reinhard
authors.initials: R
authors.lastname: Feneberg
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Müller-Wiefel
authors.forename: Nesrin
authors.initials: N
authors.lastname: Besbas
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zurowska
authors.forename: Nejat
authors.initials: N
authors.lastname: Aksu
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.forename: Ernesto
authors.initials: E
authors.lastname: Sojo
authors.forename: Osman
authors.initials: O
authors.lastname: Donmez
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.forename: Aydan
authors.initials: A
authors.lastname: Sirin
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alexander
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D013997:Time Factors