Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children: Insights From the International Pediatric Peritoneal Dialysis Network Registry
Status PubMed-not-MEDLINE Language English Country United States Media electronic-ecollection
Document type Journal Article
PubMed
38899186
PubMed Central
PMC11184244
DOI
10.1016/j.ekir.2024.03.031
PII: S2468-0249(24)01618-8
Knihovny.cz E-resources
- Keywords
- Enterobacterales, PD-associated peritonitis, Pseudomonas, children, gram-negative,
- Publication type
- Journal Article MeSH
INTRODUCTION: Gram-negative peritonitis (GNP) is associated with significant morbidity in children receiving long-term peritoneal dialysis (PD) and current treatment recommendations are based on limited data. METHODS: Analysis of 379 GNP episodes in 308 children (median age 6.9 years, interquartile range [IQR]: 3.0-13.6) from 45 centers in 28 countries reported to the International Pediatric Peritoneal Dialysis Network registry between 2011 and 2023. RESULTS: Overall, 74% of episodes responded well to empiric therapy and full functional recovery (FFR) was achieved in 82% of cases. In vitro bacterial susceptibility to empiric antibiotics and lack of severe abdominal pain at onset were associated with a good initial response. Risk factors for failure to achieve FFR included severe abdominal pain at onset and at 60 to 72 hours from treatment initiation (odds ratio [OR]: 3.81, 95% confidence interval [CI]: 2.01-7.2 and OR: 3.94, 95% CI: 1.06-14.67, respectively), Pseudomonas spp. etiology (OR: 1.73, 95% CI: 1.71-4.21]) and in vitro bacterial resistance to empiric antibiotics (OR: 2.40, 95% CI: 1.21-4.79); the risk was lower with the use of monotherapy as definitive treatment (OR: 0.40, 95% CI: 0.21-0.77). Multivariate analysis showed no benefit of dual antibiotic therapy for treatment of Pseudomonas peritonitis after adjustment for age, presenting symptomatology, 60 to 72-hour treatment response, and treatment duration. Monotherapy with cefazolin in susceptible Enterobacterales peritonitis resulted in a similar FFR rate (91% vs. 93%) as treatment with ceftazidime or cefepime monotherapy. CONCLUSION: Detailed microbiological assessment, consisting of patient-specific and center-specific antimicrobial susceptibility data, should guide empiric treatment. Treatment "deescalation" with the use of monotherapy and narrow spectrum antibiotics according to susceptibility data is not associated with inferior outcomes and should be advocated in the context of emerging bacterial resistance.
Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
Children's Memorial Health Institute Warsaw Poland
Children's Mercy Kansas City Kansas City Missouri USA
Children's University Hospital Belgrade Serbia
Department for Pediatrics Nephrology and Hypertension Medical University of Gdańsk Gdańsk Poland
Department of Pediatrics Clinical Sciences Lund Lund University Lund Sweden
Department of Pediatrics Yong Loo Lin School of Medicine National University of Singapore Singapore
Division of Pediatric Nephrology Hospital for Maria Ludovica La Plata Argentina
Gazi University Hospital Ankara Turkey
IRCCS Instituto Giannina Gaslini Genoa Italy
Johns Hopkins University School of Medicine Baltimore Maryland USA
Nationwide Children's Hospital Columbus Ohio USA
NRS Medical College and Hospital Kolkata India
Pediatric Nephrology Centre Hong Kong Children's Hospital Kowloon Bay Hong Kong SAR
Pediatric Nephrology Pédiatrie 1 Centre Hospitalier Universitaire de Strasbourg France
Roberto del Rio Hospital Chile
University Center for Pediatrics and Adolescent Medicine Heidelberg Germany
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