Division of Nephrology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.
Pediatr Nephrol. 2010 Jun;25(6):1147-51. doi: 10.1007/s00467-010-1456-7. Epub 2010 Feb 16.
Pediatric peritoneal dialysis (PD) patients are at risk for acute peritonitis. One risk factor is accidental exposure of the catheter to a non-sterile surface. We studied catheter exposures in 17 pediatric patients receiving PD who developed 16 holes and 12 other accidental exposures. The rate of exposures was 3.7 events/100 patient-months. After exposure, the mean counts (+ or - standard error) of white blood cells (WBC), red blood cells, and neutrophils were 39.8 + or - 19.3, 9.5 + or - 7.1, and 24.2 + or - 5.3/mm(3), respectively. There was a trend towards higher peritoneal fluid WBC in patients with holes than in those with exposures (60.1 + or - 34.8 vs. 15.4 + or - 5.1/mm(3), respectively; p = 0.2). The initial peritoneal fluid WBC count was significantly higher if there was a positive culture than a negative culture (165.0 + or - 132.6 vs. 20.3 + or - 6.4/mm(3), respectively; p = 0.01). The percentage of neutrophils was higher in patients with a positive culture than in those with a negative culture (54.7 + or - 14.1 vs. 19.1 + or - 4.9%, respectively; p = 0.01). Of the 28 patients, 27 received a single dose of intravenous antibiotics, as per the protocol at that time. Among those treated, 7% developed a positive culture (all staphylococcal species) while 93% had a negative culture. We conclude that following accidental exposure of the peritoneal dialysis catheter: (1) the prevalence of peritonitis is low; (2) measuring peritoneal fluid WBC provides treatment guidance; (3) if treatment is initiated, it should be applied intraperitoneally and include activity against Gram-positive organisms.
儿科患者腹膜透析（PD）有发生急性腹膜炎的风险。一个风险因素是导管意外接触到非无菌表面。我们研究了 17 名接受 PD 的儿科患者的导管暴露情况，这些患者发生了 16 个孔和 12 个其他意外暴露。暴露的发生率为 3.7 次/100 患者-月。暴露后，白细胞（WBC）、红细胞和中性粒细胞的平均计数（+或-标准误差）分别为 39.8+或-19.3、9.5+或-7.1 和 24.2+或-5.3/mm³。孔的患者与暴露的患者相比，腹膜液 WBC 有升高的趋势（分别为 60.1+或-34.8 和 15.4+或-5.1/mm³；p=0.2）。如果培养阳性，初始腹膜液 WBC 计数显著更高（165.0+或-132.6 和 20.3+或-6.4/mm³；p=0.01）。培养阳性的患者中性粒细胞百分比高于培养阴性的患者（分别为 54.7+或-14.1 和 19.1+或-4.9%；p=0.01）。在 28 名患者中，27 名患者根据当时的方案接受了单剂量静脉内抗生素治疗。在接受治疗的患者中，7%的患者培养阳性（均为葡萄球菌属），而 93%的患者培养阴性。我们得出结论，在腹膜透析导管意外暴露后：（1）腹膜炎的患病率较低；（2）测量腹膜液 WBC 可提供治疗指导；（3）如果开始治疗，应腹腔内给药，包括针对革兰阳性菌的治疗。
