ESPN 54th Annual Meeting

ESPN 2022


 
Management of dialysis associated peritonitis: Does guideline adherence pay off?
DAGMARA BORZYCH-DUZALKA 1 KAREL VONDRAK 2 TELMA FRANCISCO 3 CHARLOTTE SAMAILLE 4 MARIA SZCZEPANSKA 5 JULIA THUMFART 6 RENATA VITKEVIC 7 ELENA CODINA 8 DIVINA KRUSCIC 9 KLAUS ARBEITER 1 HEE GUNG KANG 10 ZENAIDA L ANTONIO 11 BRADLEY A WARADY 12 FRANZ SCHAEFER 13

1- MEDICAL UNIVERSITY OF GDANSK, GDANSK, POLAND
2- UNIVERSITY HOSPITAL MOTOL, PRAGUE, CZECH REPUBLIC
3- CENTRO HOSPITALAR E UNIVERSITáRIO DE LISBOA CENTRAL, LISBON, PORTUGAL
4- SERVICE DE NéPHROLOGIE PéDIATRIQUE, HôPITAL JEANNE DE FLANDRE, LILLE, FRANCE.
5- MEDICAL UNIVERSITY OF SILESIA, ZABRZE, POLAND
6- VIRCHOW-KLINIKUM, CHARITE, BERLIN, GERMANY
7- VILNIUS UNIVERSITY HOSPITAL, VILNIUS, LITHUANIA
8- HOSPITAL SANT JOAN DE DEU, BARCELONA, SPAIN
9- UNIVERSITY CHILDRENS HOSPITAL, BELGRADE, SERBIA
10- SEOUL NATIONAL UNIVERSITY CHILDRENS HOSPITAL, SEOUL, SOUTH KOREA.
11- NATIONAL KIDNEY AND TRANSPLANT INSTITUTE, QUEZON CITY, PHILIPPINES
12- CHILDRENS MERCY HOSPITAL, KANSAS CITY, USA
13- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG UNIVERSITY, HEIDELBERG, GERMANY.
 
Introduction:

Peritonitis is a significant risk factor for technique failure in children receiving chronic peritoneal dialysis (PD).  The aim of the study was describe management and outcome peritonitis experienced by patients followed in the International Pediatric Peritoneal Dialysis Network (IPPN) Registry.  

Material and methods:

Review of peritonitis episodes submitted to the IPPN registry (www.pedpd.org) between 04/2007 and 01/2022.

Results:

A total of 2107 peritonitis episodes were reported to the IPDN registry between 2007 and 2022.  Within 3 days of empiric antibiotic therapy 76% of patients were asymptomatic with clear dialysis effluent. The clinical response rate was significantly (p<0.0001) better in gram positive (97%) and culture negative (95%) as compared to gram negative episodes (77%).  Response  rates were identical (89%) in patients receiving glycopeptide/ceftazidime and those treated with  cefazoline/ceftazidime. The resistance rate of gram-positive bacteria to methicillin was high with significant regional variability ranging from 19% in Western Europe to 49% in Central Europe, while glycopeptide sensitivity was 92-100%. Gram negative sensitivity to ceftazidime ranged from 59% in Latin America to 100% in North America, aminoglycoside sensitivity was 76-100%. The overall sensitivity of causative organisms to cefepime was 71-100%. 79% of peritonitis episodes were treated empirically according to the pediatric ISPD guidelines: 37% of episodes were treated empirically with glycopeptide/ceftazidime, 28% with cefazoline/ceftazidime, 7% with glycopeptide/cefepime, 4% with glycopeptide/ aminoglycoside, 3% with cefazoline/cefepime and 4 episodes (<1%) with cefepime monotherapy. The rate of adherence to the empiric therapy treatment schedule recommended by ISPD varied regionally, ranging from 58% in Asia to 83% in Western Europe (p<0.0001). Permanent or temporary discontinuation of PD was significantly more common in patients treated empirically by other protocols than recommended in the ISPD guidelines (23% v. 16%, p<0.001), without significant regional variation.

 

 

Conclusions:

Treatment of PD-associated peritonitis according to international consensus guidelines is results in superior clinical outcomes in children.