title: Gram-negative organisms in peritoneal dialysis peritonitis: an early indication for surgery in patients with haemolytic uraemic syndrome?
abstract: OBJECTIVE
  Haemolytic uraemic syndrome (HUS) is the commonest childhood cause of acute renal failure. Peritoneal dialysis peritonitis (PDP) is a well-recognised complication, with some children requiring surgical intervention (SI). The aim of this study is to determine whether the presence of enteric organisms in cases of PDP might predict the need for SI.
  
  
  METHODS
  Retrospective, 5-year (2009-2014) case note review of all HUS cases requiring PD presenting to a single centre. Mann-Whitney U test was used for continuous non-parametric data and χ (2) for categorical data.
  
  
  RESULTS
  48 children required PD for HUS, 18/48 (38 %) developed PDP and of these 5/18 (28 %) required SI (subtotal colectomy n = 4, small bowel resection n = 1). Peritoneal fluid was cultured as part of the work-up for PDP. The presence of enteric organisms was associated with a 10.4 fold relative risk of requiring surgery (p = 0.02, 95 % CI 1.5-71.9), with 4/5 of these patients requiring surgery (median 17 days post-culture result). Only 1/13 patients not requiring surgery grew gram-negative bacteria.
  
  
  CONCLUSIONS
  The presence of enteric bacteria in patients with PDP significantly decreases the chances of successful conservative management. In these patients early involvement of the surgical team is essential with a low threshold for SI.
authors.affiliation: Royal Manchester Children's Hospital, Manchester, UK. rvharwood@hotmail.com.
authors.forename: Rachel
authors.identifier: http://orcid.org/0000-0003-3440-3142
authors.initials: R
authors.lastname: Harwood
authors.affiliation: Liverpool University, Liverpool, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wilkinson
authors.affiliation: Manchester University, Manchester, UK.
authors.forename: Shweta
authors.initials: S
authors.lastname: Ramkumar
authors.affiliation: Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Humphrey
mesh_terms: D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000150:complications*; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000382:microbiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies
keywords: Enteric bacteria; Gram-negative organisms; Haemolytic Uraemic Syndrome; Paediatric; Peritoneal dialysis; Peritonitis; Surgery