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Boletín Médico del Hospital Infantil de México

2007, Number 4

Bol Med Hosp Infant Mex 2007; 64 (4)

Peritonitis secondary to dialysis in patients with chronic renal insufficiency. Report of six years in a tertiary care level

Morales-Aguirre JJ, Argüelles-Guerrero AG

Language: Spanish
References: 26
Page: 221-230
PDF size: 183.19 Kb.


ABSTRACT

Introduction. There is little information on peritonitis associated to peritoneal dialysis, which is one of the main complications in patients under this procedure in Mexico.
Methods. Retrospective, cross-sectional study of a series of cases carried out in the Hospital Infantil de Mexico Federico Gomez. Children aged from one month to 18 years, with diagnosis of peritonitis associated to peritoneal dialysis, during the period of January 2000 to December 2005 were included. The aim of this study was to describe the clinical and laboratory findings of patients with peritonitis associated to peritoneal dialysis, as well as mortality.
Results. Out of 136 patients, 75 (55.1%) were male. The mean age was 12.94 years. In 104 cases (76.4%) a Tenckhoff catheter was used. In 89 cases, peritonitis occurred during the training to relatives for ambulatory continuous peritoneal dialysis. The main clinical findings were abdominal pain (63.9%), solution turbidity (56.6%), and fever (31.6%). Seventy-four microorganisms were isolated in 69 cases; more than one germ was found in 5 cases. Staphylococcus aureus and coagulase-negative Staphylococcus were the most frequent microorganisms. The gramnegative bacilli were Escherichia coli and Pseudomonas aeruginosa. Regarding antimicrobial sensitivity patterns performed in 47 isolations, 17 corresponded to S. aureus and were sensitive to methicillin and vancomycin. Coagulase-negative Staphylococcus (8 isolations) were 50% resistant to methicillin and 100% sensitive to vancomycin. Enterococcus sp. (4 isolations) was vancomycin-sensitive, whereas P. aeruginosa (5 isolations) was sensitive to ceftazidime, cefepime, amikacin, and carbapenems. E. coli, Klebsiella pneumoniae, and Proteus mirabilis (12 isolations) were sensitive to third- and fourth-generation cephalosporins, aminoglycosides and carbapenems. Observed mortality was of 6/99 (6%); the main factors associated to mortality were polymicrobial isolation and thrombocytopenia (≤ 100 000, P ‹0.05).
Conclusions. Peritonitis associated to peritoneal dialysis is an important cause of morbidity. The main agents are grampositive Staphylococcus, and main incidence of peritonitis occurs during ambulatory continuous peritoneal dialysis training.


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