Peritonitis and exit-site infection in pediatric automated peritoneal dialysis

• Published in: Peritoneal dialysis international 2008-06, Vol.28 Suppl 3 (3_suppl), p.S179-182
• Main Authors: Chiu, Man-Chun, Tong, Pak-Chiu, Lai, Wai-Ming, Lau, Shing-Chi
• Format: Article
• Language: English
• Subjects: Adolescent; Catheters, Indwelling - adverse effects; Child; Child, Preschool; Female; Hong Kong - epidemiology; Humans; Incidence; Infant; Infant, Newborn; Male; Methicillin Resistance; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - methods; Peritonitis - epidemiology; Peritonitis - microbiology; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - microbiology; Retrospective Studies; Skin Diseases, Bacterial - epidemiology; Skin Diseases, Bacterial - microbiology; Staphylococcal Infections - microbiology; Staphylococcus - isolation & purification; Streptococcal Infections - microbiology; Streptococcus - isolation & purification
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080802803s33

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.