Catheter related infections in children on continuous ambulatory peritoneal dialysis at tertiary care hospital in Mumbai
Journal Title: Medpulse International Journal of Pediatrics - Year 2018, Vol 7, Issue 3
Abstract
Context: Continuous ambulatory peritoneal dialysis (CAPD) is a bridge between ESRD and renal transplant. One of the factors hindering the widespread use of CAPD in children is the high risk of infections and subsequent need for catheter removal. The current study was undertaken to assess the prevalence, microbiology, treatment and outcome of catheter related infections in a tertiary care hospital in Mumbai, Maharashtra, India. Methods: It was retrospectively analyzed data of 27 patients with end stage renal disease on CAPD who were on regular follow up at Pediatric Nephrology division of Bai Jerbai Wadia Hospital for children, Mumbai. Details of their catheter related infections (CRI) including spontaneous bacterial peritonitis (SBP), tunnel infections (TI), and exit site infections (ESI) were recorded. Results of microbiology, treatment and outcome of these infections were also analyzed. Results: Out of 27 patients, (15 male) with mean age of 7 years (range 11 months - 16 years), were followed up for a total of 657 CAPD months. A total of 39 episodes of CRI occurred in 16 patients. Out of these, 25(64%) were spontaneous bacterial peritonitis, 8(20.5%) were exit sit infections and 6(15.3%) were tunnel infections. Among SBP, 6/25(24%) and among ESI 5/8(62.5%) were culture positive. Gram negative organisms (54%) were the most commonly isolates followed by gram positives (27%) and fungus (18%) as causes of SBP. Catheter related infections necessitated catheter removal in 8 patients (6 SBP, 1 ESI, and 1 TI). None of the ESIs or TIs progressed to SBP. SBP rate was 1 episode per 33.3 patient months. Monsoon season had maximum episodes (43%) of CRI. None out of 7 deaths was directly attributable to CRIs. Conclusion: Continuous ambulatory peritoneal dialysis is a safe modality of renal replacement therapy in children. If ESI or tunnel infections are managed aggressively, progression to SBP can be prevented. Prompt treatment of CRI may help to salvage catheters in these patients.
Authors and Affiliations
Alpana Ohri, Jalpa Dave, Amish Udani
Keywords
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- DOI 10.26611/1014735
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