Peritonitis and exit-site infection in pediatric automated peritoneal dialysis.
We reviewed 30 patients in an automated peritoneal dialysis (APD) program from 2002 to 2006 for peritonitis. Patients were 11.6 +/- 5.5 years old at initiation of peritoneal dialysis (PD) and had a total of 976 PD months. The overall peritonitis rate was 1 episode in 54.2 patient-months, for a rate of 0.22 episode annually. The rate was considered low, which other than being an APD program, may be attributed to adherence to guidelines and in-charge nurse policy. A total of 17 episodes of peritonitis were identified in 9 patients, and the distribution of patient-specific peritonitis incidence appeared bimodal: 87% patients had no or only 1 episode of peritonitis, and 4 patients accounted for 12 episodes, with an average peritonitis rate of 1.0 annually. Causative organisms included Staphylococcus aureus, coagulase-negative Staphylococcus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, enterococci, alpha-hemolytic Streptococcus. Five episodes had concurrent exit-site infection with the same organism. During the same period in these 30 patients, 40 episodes of exit-site infection (ESI) were recorded in 23 patients. The overall ESI rate was 1 episode in 24.4 PD months. S. aureus and Pseudomonas aeruginosa were the two most common pathogens, accounting for 70% of the infections. Nasal carriage of MRSA was found in 4 patients, and MRSA ESIs in 2. The ESI rate was not low as that observed in peritonitis, which may be attributed to the humid climate.
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China. chiumc@ha.org.hk
Man-Chun
MC
Chiu
Pak-Chiu
PC
Tong
Wai-Ming
WM
Lai
Shing-Chi
SC
Lau
D000293:Adolescent; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology; D013210:Staphylococcus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000382:microbiology; D013291:Streptococcus / Q000302:isolation & purification