1 - Medical University of Gdansk, Pediatrics, Nephrology and Hypertension, Gdansk, Poland
2 - Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, German
3 - Gazi University Hospital, Gazi, Turkey
4 - Great Ormond Street Hospital, London, London, United Kingdom
5 - Hôpital Femme Mere Enfant, Lyon, France
6 - Hôpital Jeanne De Flandre, Lille, France
7 - Vilnius University Hospital, Vilnius, Lithuania
8 - Hospital D. Estefânia,Centro Hospitalar Universitário, Lisboa, Portugal
9 - Cukurova University, Adana, Turkey
10 - Pediatric Clinic, Nephrology Unit, Skopje, Macedonia
11 - University Children’s Hospital, Belgrade, Serbia
12 - CHU Arnaud de Villeneuve, Montpellier, France
13 - Barnkliniken, Lund, Sweden
14 - Medical University of Warsaw, Warsaw, Poland
15 - Children’s Mercy Hospital, Kansas City, USA
- 56th Annual Meeting of the European Society for Paediatric Nephrology, 24-26/9/2024, Valência, Espanha, Comunicação oral
- Resumo publicado em: Pediatr Nephrol 2024;39(Suppl 1):S134
Abstract:
Purpose: To assess the incidence and treatment outcomes of peritoneal dialysis (PD) associated culture-negative peritonitis (CNP) in children.
Methods: Analysis of peritonitis episodes reported to the IPPN registry between 2007 and 2023. Outcome parameters include full functional recovery as defined by PD continuation without ultrafiltration problems, adhesions or uncontrolled infection, PD discontinuation and peritonitis relapse rate.
Results: Of 2589 peritonitis episodes, 781 (30%) were culture-negative, with an incidence of 0.1 per patient year. The fraction and incidence of CNP assessed in 50 centers reporting > 10 peritonitis episodes and > 20 pt year observation time varied significantly between centers (range 0-87% and 0 to 0.41/yr, respectively) and world regions, being lowest in North America (15%, 0.07/yr) and highest in Latin America (LA) and Turkey (43/40%, 0.18/0.16/yr; NA vs. LA/Turkey all p < 0.0001). The cumulative treatment duration was shorter than 14 days (median 10, IQR 8-12 days) in 91, 14 days in 418 and longer than two weeks (median 20, IQR 17-21 days) in 272 episodes. Full functional recovery /FFR) was achieved in 71%, 91% and 86% for ‘ < 14’, ‘14’ and ‘ > 14’ days, respectively (p < 0.0001, adjusting for age and disease severity at onset). PD was discontinued in 11%, 2.6% and 4.8% for ‘ < 14’, ‘14’ and ‘ > 14’ days, respectively (p =0.007, adjusted for age and disease severity). 82 (11%) episodes were followed by relapse (59% again culture-negative, 23% gram-negative, 15% gram-positive, 2% fungal and 1% multiple organisms), without significant differences between treatment duration groups. In 318 episodes treated for 14 days, empiric therapy with either vancomycin/ceftazidime (n = 180) or cefazolin/ceftazidime (n = 138) was applied. In 276 (87%) of these, the initial antibiotic scheme was continued unchanged after receiving negative culture results. Among these cases, FFR was observed in 94% of vancomycin and 90% of cefazolin treated episodes (p =0.19). PD was discontinued in 1 vancomycin and in 3 cefazolin treated episodes (p =0.24). 14% of vancomycin and 11% of cefazolin treated episodes were followed by relapse (p =0.32). In 42/318 patients cefazolin was changed to vancomycin and 9 from vancomycin to cefazolin, with full functional recovery rates 79% vs, 67%, p =0.45 and 1 PD discontinuation and in each group. 6 relapses were reported in patients who were switched from cefazolin to vancomycin.
Conclusions: Rates of culture-negative peritonitis are still common, particularly in lower resource areas and show significant regional and center-related variation. Antibiotic treatment of gram-negative peritonitis should not be shortened to below 14 days. Since similarly good outcomes were observed with vancomycin and cefazolin, in view of emerging antimicrobial multiresistance the latter should be considered once culture-negative results are obtained.
Keywords: children, culture-negative peritonitis, peritoneal dyalisis