Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children : Insights From the International Pediatric Peritoneal Dialysis Network Registry

Borzych-Dużałka, Dagmara ; Same, Rebeca ; Neu, Alicia ; Yap, Hui Kim ; Verrina, Enrico ; Bakkaloglu, Sevcan A. ; Cano, Francisco ; Patel, Hiren ; Szczepańska, Maria and Obrycki, Łukasz , et al. (2024) In Kidney International Reports 9(6). p.1654-1663
Abstract

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... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
keywords
children, Enterobacterales, gram-negative, PD-associated peritonitis, Pseudomonas
in
Kidney International Reports
volume
9
issue
6
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:38899186
  • scopus:85190308940
ISSN
2468-0249
DOI
10.1016/j.ekir.2024.03.031
language
English
LU publication?
yes
id
81921dbe-2fda-4a37-a867-b8b33dda1dce
date added to LUP
2025-01-13 14:32:41
date last changed
2025-04-04 04:36:37
@article{81921dbe-2fda-4a37-a867-b8b33dda1dce,
  abstract     = {{<p>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.</p>}},
  author       = {{Borzych-Dużałka, Dagmara and Same, Rebeca and Neu, Alicia and Yap, Hui Kim and Verrina, Enrico and Bakkaloglu, Sevcan A. and Cano, Francisco and Patel, Hiren and Szczepańska, Maria and Obrycki, Łukasz and Spizzirri, Ana Paula and Sartz, Lisa and Vondrak, Karel and Rebori, Anabella and Milosevski-Lomic, Gordana and Chan, Eugene Yu hin and Basu, Biswanath and Pezo, Andrea Lazcano and Zaloszyc, Ariane and Chadha, Vimal and Schaefer, Franz and Warady, Bradley A.}},
  issn         = {{2468-0249}},
  keywords     = {{children; Enterobacterales; gram-negative; PD-associated peritonitis; Pseudomonas}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1654--1663}},
  publisher    = {{Elsevier}},
  series       = {{Kidney International Reports}},
  title        = {{Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children : Insights From the International Pediatric Peritoneal Dialysis Network Registry}},
  url          = {{http://dx.doi.org/10.1016/j.ekir.2024.03.031}},
  doi          = {{10.1016/j.ekir.2024.03.031}},
  volume       = {{9}},
  year         = {{2024}},
}