title: Relapsing peritonitis in children who undergo chronic peritoneal dialysis: a prospective study of the international pediatric peritonitis registry.
abstract: 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.
authors.affiliation: 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
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Lane
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Reinhard
authors.initials: R
authors.lastname: Feneberg
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Majkowski
authors.forename: Alan R
authors.initials: AR
authors.lastname: Watson
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.forename: Hee Gyung
authors.initials: HG
authors.lastname: Kang
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Bonzel
authors.forename: Eva
authors.initials: E
authors.lastname: Simkova
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alexander
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.forename: Ilmay
authors.initials: I
authors.lastname: Bilge
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents