Rachel Harwood1, David Wilkinson2, Shweta Ramkumar3, Gillian Humphrey4. 1. Royal Manchester Children's Hospital, Manchester, UK. rvharwood@hotmail.com. 2. Liverpool University, Liverpool, UK. 3. Manchester University, Manchester, UK. 4. Royal Manchester Children's Hospital, Manchester, UK.
Abstract
PURPOSE: Haemolytic uraemic syndrome (HUS) is the commonest childhood cause of acute renal failure. Peritoneal dialysis peritonitis (PDP) is a well-recognised complication, with some children requiring surgical intervention (SI). The aim of this study is to determine whether the presence of enteric organisms in cases of PDP might predict the need for SI. METHODS: Retrospective, 5-year (2009-2014) case note review of all HUS cases requiring PD presenting to a single centre. Mann-Whitney U test was used for continuous non-parametric data and χ (2) for categorical data. RESULTS: 48 children required PD for HUS, 18/48 (38 %) developed PDP and of these 5/18 (28 %) required SI (subtotal colectomy n = 4, small bowel resection n = 1). Peritoneal fluid was cultured as part of the work-up for PDP. The presence of enteric organisms was associated with a 10.4 fold relative risk of requiring surgery (p = 0.02, 95 % CI 1.5-71.9), with 4/5 of these patients requiring surgery (median 17 days post-culture result). Only 1/13 patients not requiring surgery grew gram-negative bacteria. CONCLUSION: The presence of enteric bacteria in patients with PDP significantly decreases the chances of successful conservative management. In these patients early involvement of the surgical team is essential with a low threshold for SI.
PURPOSE:Haemolytic uraemic syndrome (HUS) is the commonest childhood cause of acute renal failure. Peritoneal dialysis peritonitis (PDP) is a well-recognised complication, with some children requiring surgical intervention (SI). The aim of this study is to determine whether the presence of enteric organisms in cases of PDP might predict the need for SI. METHODS: Retrospective, 5-year (2009-2014) case note review of all HUS cases requiring PD presenting to a single centre. Mann-Whitney U test was used for continuous non-parametric data and χ (2) for categorical data. RESULTS: 48 children required PD for HUS, 18/48 (38 %) developed PDP and of these 5/18 (28 %) required SI (subtotal colectomy n = 4, small bowel resection n = 1). Peritoneal fluid was cultured as part of the work-up for PDP. The presence of enteric organisms was associated with a 10.4 fold relative risk of requiring surgery (p = 0.02, 95 % CI 1.5-71.9), with 4/5 of these patients requiring surgery (median 17 days post-culture result). Only 1/13 patients not requiring surgery grew gram-negative bacteria. CONCLUSION: The presence of enteric bacteria in patients with PDP significantly decreases the chances of successful conservative management. In these patients early involvement of the surgical team is essential with a low threshold for SI.
Authors: J Cordero; J Baeza; O Fielbaum; C Saieh; M Varela; E Rodríguez; P Olivos; C Hernández; J González Journal: Rev Chil Pediatr Date: 1990 Sep-Oct
Authors: Sebastian Loos; Thurid Ahlenstiel; Brigitta Kranz; Hagen Staude; Lars Pape; Christoph Härtel; Udo Vester; Laura Buchtala; Kerstin Benz; Bernd Hoppe; Ortraud Beringer; Martin Krause; Dominik Müller; Martin Pohl; Johanna Lemke; Georg Hillebrand; Martin Kreuzer; Jens König; Marianne Wigger; Martin Konrad; Dieter Haffner; Jun Oh; Markus J Kemper Journal: Clin Infect Dis Date: 2012-06-05 Impact factor: 9.079