Relapsing peritonitis in children who undergo chronic peritoneal dialysis: a prospective study of the international pediatric peritonitis registry.
OBJECTIVE
The International Pediatric Peritonitis Registry (IPPR) was established to collect prospective data regarding peritoneal dialysis (PD)-associated peritonitis in children. In this report, we present the IPPR results that pertain to relapsing peritonitis (RP).


METHODS
This was an online, prospective entry into the IPPR of data that pertain to peritonitis cases by participating centers.


RESULTS
Of 490 episodes of nonfungal peritonitis, 52 (11%) were followed by a relapse. There was no significant difference between RP and non-RP in distribution of causative organisms and antibiotic sensitivities. Initial empiric therapy-ceftazidime with either first-generation cephalosporin or glycopeptide (vancomycin or teicoplanin)-was not associated with relapse. Switching to monotherapy with a first-generation cephalosporin on the basis of culture results was associated with higher relapse rate (23%) than other final antibiotic therapies (0 to 9%). Culture-negative RP was less likely to have a satisfactory early treatment response than non-RP (82 versus 98%). Young age, single-cuff catheter, downward-pointing exit site, and chronic systemic antibiotic prophylaxis were additional independent risk factors for RP in the multivariate analysis. Compared with non-RP, RP was associated with a lower rate of full functional recovery (73 versus 91%), higher ultrafiltration problems (14 versus 2%), and higher rate of permanent PD discontinuation (17 versus 7%).


CONCLUSIONS
This is the largest multicenter, prospective study to date to examine RP in children. In addition, this is the first report in the literature to examine specifically the relationship of postempiric antibiotic treatment regimens to the subsequent risk for relapse.
Lane
Jerome C
JC
Division of Kidney Diseases, Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA. j-lane@northwestern.edu
Warady
Bradley A
BA
Feneberg
Reinhard
R
Majkowski
Nancy L
NL
Watson
Alan R
AR
Fischbach
Michel
M
Kang
Hee Gyung
HG
Bonzel
Klaus E
KE
Simkova
Eva
E
Stefanidis
Constantinos J
CJ
Klaus
Günter
G
Alexander
Steven R
SR
Ekim
Mesiha
M
Bilge
Ilmay
I
Schaefer
Franz
F
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000378:metabolism; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000900:Anti-Bacterial Agents