Division of Kidney Diseases, Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA.
Clin J Am Soc Nephrol. 2010 Jun;5(6):1041-6. doi: 10.2215/CJN.05150709. Epub 2010 Apr 29.
The International Pediatric Peritonitis Registry (IPPR) was established to collect prospective data regarding peritoneal dialysis (PD)-associated peritonitis in children. In this report, we present the IPPR results that pertain to relapsing peritonitis (RP).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was an online, prospective entry into the IPPR of data that pertain to peritonitis cases by participating centers.
Of 490 episodes of nonfungal peritonitis, 52 (11%) were followed by a relapse. There was no significant difference between RP and non-RP in distribution of causative organisms and antibiotic sensitivities. Initial empiric therapy-ceftazidime with either first-generation cephalosporin or glycopeptide (vancomycin or teicoplanin)-was not associated with relapse. Switching to monotherapy with a first-generation cephalosporin on the basis of culture results was associated with higher relapse rate (23%) than other final antibiotic therapies (0 to 9%). Culture-negative RP was less likely to have a satisfactory early treatment response than non-RP (82 versus 98%). Young age, single-cuff catheter, downward-pointing exit site, and chronic systemic antibiotic prophylaxis were additional independent risk factors for RP in the multivariate analysis. Compared with non-RP, RP was associated with a lower rate of full functional recovery (73 versus 91%), higher ultrafiltration problems (14 versus 2%), and higher rate of permanent PD discontinuation (17 versus 7%).
This is the largest multicenter, prospective study to date to examine RP in children. In addition, this is the first report in the literature to examine specifically the relationship of postempiric antibiotic treatment regimens to the subsequent risk for relapse.
国际儿科腹膜炎登记处（IPPR）成立的目的是收集儿童腹膜透析（PD）相关性腹膜炎的前瞻性数据。在本报告中，我们将介绍与复发性腹膜炎（RP）相关的 IPPR 结果。
设计、地点、参与者和测量：这是一项在线、前瞻性的 IPPR 数据登记，涉及参与中心的腹膜炎病例。
在 490 例非真菌性腹膜炎发作中，有 52 例（11%）出现了复发。RP 和非 RP 之间在病原体分布和抗生素敏感性方面没有显著差异。初始经验性治疗——头孢他啶联合第一代头孢菌素或糖肽（万古霉素或替考拉宁）——与复发无关。根据培养结果改用第一代头孢菌素单药治疗的复发率（23%）高于其他最终抗生素治疗（0%至 9%）。文化阴性 RP 的早期治疗反应不如非 RP 满意（82%比 98%）。在多变量分析中，年龄较小、单袖口导管、指向下方的出口部位和慢性全身抗生素预防是 RP 的其他独立危险因素。与非 RP 相比，RP 与较低的完全功能恢复率（73%比 91%）、更高的超滤问题（14%比 2%）和更高的 PD 永久停用率（17%比 7%）相关。
这是迄今为止最大的多中心、前瞻性研究，旨在检查儿童中的 RP。此外，这是文献中首次专门检查经验后抗生素治疗方案与随后复发风险之间的关系的报告。
