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Peritonitis is a significant risk factor for peritoneal dialysis (PD) technique failure in children receiving chronic PD. The IPPN is the only source of pediatric PD infection related data obtained on a global basis.
To describe the peritonitis rate, etiology, antibiotic susceptibility, clinical presentation and outcome experienced by patients whose data was entered into the IPPN registry.
Review of prospectively collected data submitted to the IPPN registry via an Internet-based web platform (www.pedpd.org) between 2007-2015. Data pertaining to patient characteristics, dialysis modality, microbiological results, and final outcome were submitted prospectively along the course of a peritonitis episode. The statistics were performed by univariate and multivariable logistic regression analysis.
Data from 3,162 patients in 43 countries was entered into the registry. The highest percentage of patients came from Western Europe (24%) and Asia/ME (23%). Sixty-six % of the patient were < 12 years of age and automated PD was the predominant PD modality. Overall, there were 2021 episodes of peritonitis reported in 1052 patients with an annualized peritonitis rate of 0.44. The annualized rate varied by region (p=0.01) with the lowest rates present in Asia/ME (0.3) and North America (0.38). Risk factors for peritonitis included use of CAPD vs. APD (OR 1.13, p=0.01), upward pointing exit site (OR 1.26, P < 0.001) and presence of any ostomy (OR=1.95, p < 0.001), Clinical symptomatology was greatest with gram negative associated episodes (p < 0.001). S. Aureus and S. Epidermidis were the most frequently isolated organisms and culture negative peritonitis was most common in Turkey and Latin America. Significant regional variation in antibiotic susceptibility was noted for aminoglycosides and methicillin. Full functional recovery occurred in 82% of cases, with no regional variation. 175 patients (8.7%) permanently discontinued PD following peritonitis.-
Peritonitis remains a frequent complication associated with the performance of PD in children. Attention to risk factors for infection may help decrease the regional variation present in the rate of peritonitis. Risk factors for culture negative peritonitis in specific global regions should continue to be sought.
Warady, Bradley; Borzych-Duzalka, Dagmara; and Schaefer, Franz, "Worldwide Experience with Peritonitis in Children: A Report from the International Pediatric Peritoneal Dialysis Network (IPPN)" (2019). Research at Children's Mercy Month 2019. 9.