Furth S L, Donaldson L A, Sullivan E K, Watkins S L
NAPRTCS Publications Committee, 19 Bradhurst Avenue, Box 10, Hawthorne, NY 10532, USA.
Pediatr Nephrol. 2000 Dec;15(3-4):179-82. doi: 10.1007/s004670000441.
Peritonitis and catheter-related infections remain the two most-common causes of peritoneal dialysis (PD) treatment failure. To define the frequency and risks associated with exit site/tunnel infections (ESI/TI), as well as peritonitis, in pediatric patients on PD, we undertook a retrospective cohort study of patients initiated on PD in the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). We examined demographic data and PD catheter characteristics of 1,258 patients, aged < or = 21 years, initiated on PD from 1992 to 1997. We examined the frequency and complications of ESI/TI occurring within 30 days, 6 months, and 1 year of follow-up. For peritonitis episodes, we examined patient risk factors for peritonitis. Almost 11% of patients had an ESI/TI at 30 days, 26% between 30 days and 6 months, and 30% between 6 months and 1 year of follow-up. There was no increased risk of ESI/TI associated with patient age, race, or catheter characteristics. Peritonitis occurred in dialysis patients at a rate of 1 episode per 13.2 patient months. Proportional hazards regression analysis demonstrated that black race, single-cuffed catheters, and upward pointing exit sites were independent risk factors for peritonitis in the pediatric PD population. Patients with ESI/TI had twice the risk of those without these infections of developing peritonitis or needing access revision, and an almost threefold increased risk of hospitalization for access complications/malfunction. ESI/TI occurs commonly in pediatric PD patients. These infections cause significant morbidity, through risk of peritonitis, access revision, and hospitalization for catheter complications. Further study of potentially modifiable risk factors for ESI/TI in pediatric end-stage renal disease patients is warranted.
腹膜炎和导管相关感染仍然是腹膜透析（PD）治疗失败的两个最常见原因。为了确定接受PD治疗的儿科患者出口部位/隧道感染（ESI/TI）以及腹膜炎的发生频率和相关风险，我们对北美儿科肾移植协作研究（NAPRTCS）中开始接受PD治疗的患者进行了一项回顾性队列研究。我们检查了1992年至1997年开始接受PD治疗的1258名年龄≤21岁患者的人口统计学数据和PD导管特征。我们检查了随访30天、6个月和1年时发生的ESI/TI的频率和并发症。对于腹膜炎发作，我们检查了腹膜炎的患者风险因素。近11%的患者在随访30天时发生ESI/TI，26%在30天至6个月之间发生，30%在6个月至1年之间发生。ESI/TI的风险增加与患者年龄、种族或导管特征无关。透析患者腹膜炎的发生率为每13.2患者月1次发作。比例风险回归分析表明，黑人种族、单套囊导管和出口部位向上是儿科PD人群中腹膜炎的独立危险因素。发生ESI/TI的患者发生腹膜炎或需要通路修复的风险是未发生这些感染患者的两倍，因通路并发症/功能障碍住院的风险增加近三倍。ESI/TI在儿科PD患者中很常见。这些感染通过腹膜炎风险、通路修复和因导管并发症住院导致显著的发病率。有必要进一步研究儿科终末期肾病患者中ESI/TI的潜在可改变风险因素。
