Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines.
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Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines. / Warady, Bradley A; Feneberg, Reinhard; Verrina, Enrico; Flynn, Joseph T; Müller-Wiefel, Dirk E.; Besbas, Nesrin; Zurowska, Aleksandra; Aksu, Nejat; Fischbach, Michel; Sojo, Ernesto; Donmez, Osman; Sever, Lale; Sirin, Aydan; Alexander, Steven R; Schaefer, Franz.
In: J AM SOC NEPHROL, Vol. 18, No. 7, 7, 2007, p. 2172-2179.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines.
AU - Warady, Bradley A
AU - Feneberg, Reinhard
AU - Verrina, Enrico
AU - Flynn, Joseph T
AU - Müller-Wiefel, Dirk E.
AU - Besbas, Nesrin
AU - Zurowska, Aleksandra
AU - Aksu, Nejat
AU - Fischbach, Michel
AU - Sojo, Ernesto
AU - Donmez, Osman
AU - Sever, Lale
AU - Sirin, Aydan
AU - Alexander, Steven R
AU - Schaefer, Franz
PY - 2007
Y1 - 2007
N2 - In children who are on chronic peritoneal dialysis, peritonitis is the primary complication compromising technique survival, and the optimal therapy of peritonitis remains uncertain. An Internet-based International Pediatric Peritonitis Registry was established in 47 pediatric centers from 14 countries to evaluate the efficacy and safety of largely opinion-based peritonitis treatment guidelines in which empiric antibiotic therapy was stratified by disease severity. Among a total of 491 episodes of nonfungal peritonitis entered into the registry, Gram-positive organisms were cultured in 44%, Gram-negative organisms were cultured in 25%, and cultures remained negative in 31% of the episodes. In vitro evaluation revealed 69% sensitivity of Gram-positive organisms to a first-generation cephalosporin and 80% sensitivity of Gram-negative organisms to a third-generation cephalosporin. Neither the risk factors assumed by the guidelines nor the choice of empiric therapy was predictive of either the early treatment response or the final functional outcome of the peritonitis episodes. Overall, 89% of cases achieved full functional recovery, a portion after relapsing peritonitis (9%). These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered.
AB - In children who are on chronic peritoneal dialysis, peritonitis is the primary complication compromising technique survival, and the optimal therapy of peritonitis remains uncertain. An Internet-based International Pediatric Peritonitis Registry was established in 47 pediatric centers from 14 countries to evaluate the efficacy and safety of largely opinion-based peritonitis treatment guidelines in which empiric antibiotic therapy was stratified by disease severity. Among a total of 491 episodes of nonfungal peritonitis entered into the registry, Gram-positive organisms were cultured in 44%, Gram-negative organisms were cultured in 25%, and cultures remained negative in 31% of the episodes. In vitro evaluation revealed 69% sensitivity of Gram-positive organisms to a first-generation cephalosporin and 80% sensitivity of Gram-negative organisms to a third-generation cephalosporin. Neither the risk factors assumed by the guidelines nor the choice of empiric therapy was predictive of either the early treatment response or the final functional outcome of the peritonitis episodes. Overall, 89% of cases achieved full functional recovery, a portion after relapsing peritonitis (9%). These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered.
M3 - SCORING: Zeitschriftenaufsatz
VL - 18
SP - 2172
EP - 2179
JO - J AM SOC NEPHROL
JF - J AM SOC NEPHROL
SN - 1046-6673
IS - 7
M1 - 7
ER -
