Osman DÖNMEZ, Berfin UYSAL, Okan AKACI, Mercan ÇELENK

Kronik Periton Diyalizi Uygulanan Çocuklarda Peritonitlerin Değerlendirilmesi; Tek Merkez Deneyimi

GİRİŞ ve AMAÇ: Bu çalışmada, periton diyaliz ünitemizdeki peritonit ataklarının etyolojisi, klinik bulgusu, tedavisi, görülme sıklığı ve mikrobiyolojik profili incelenmiştir. YÖNTEM ve GEREÇLER: Ocak 2004 – Aralık 2011 tarihleri arasında merkezimizde, kronik periton diyalizi ile izlenen, peritonit atağı geçirmiş olan 55 hastayı retrospektif olarak incelendi. BULGULAR: Hastalarımızda toplam 157 atak saptandı. Peritonit atak sıklığı incelendiğinde; 23,9 hasta ayında 1 atak olarak saptandı. SAPD uygulanan hastalarda atak sıklığı 26,8 hasta ayında 1 iken, APD uygulanan hastalarda 20,1 hasta ayında 1 olarak saptandı. Atakların %30,5‘inde (n=48) üreme saptanmadı,%42,6‘sında (n=67) gram pozitif üreme, %19,7‘sinde (n=31) gram negatif üreme, % 3,8 ‘inde (n=6) polimikrobial gram pozitif üreme, %0,6 ‘sında (n=1) polimikrobial gram negatif üreme, % 0,6 ‘sında ( n=1) polimikrobial kombine üreme ve % 1,9 ‘unda (n=3) diğer grup üremeler saptandı. Swanneck çift cuff periton diyaliz katateri takılı olan 42 hastada ortalama peritonit atak sayısı 3 ± 2,34 iken, tenckhoff çift cuff periton diyaliz katateri takılı olan 13 hastanın ortalama peritonit atak sayısı 2,38 ± 1,60 olarak saptandı. TARTIŞMA ve SONUÇ: Çalışmamızda, hasta yaşının, cinsiyetinin, diyalize başlama yaşının, periton diyaliz tipinin, katater tipinin, katater takılma şeklinin peritonit atak sayısını etkilemediğini gördük. Bu tespit peritonit atak sıklığını azaltmada uygulayıcı ebeveyn eğitimini sorgulamanın önemine işaret edebilir.

Anahtar Kelimeler:

kronik, periton, diyaliz, peritonit

Outcome of Peritoneal-Dialysis Related Peritonitis in Children: A Single Center Experience

INTRODUCTION: The aim of this study was to clarify the etiology, clinical presentation, treatment of peritonitis, peritonitis rate, and to analyze the microbiologic profile of peritonitis in our pediatric dialysis unit. METHODS: This study was performed with children treated with chronic peritoneal dialysis and diagnosed for peritonitis during the period from January 2004 to December 2011 at the Peritoneal Dialysis Unit of our Pediatric Nephrology Department.RESULTS: The patient cohort comprised 55 patients (30 males, 25 females) who were treated for peritoneal dialysis related peritonitis. The total number of peritonitis episodes was 157. The mean peritonitis rate was one episode per 23.9 patient-months; one episode per 26.8 patient-months for continuous ambulatory peritoneal dialysis and one episode per 20.1 patient-months for automated peritoneal dialysis. The yield of culture positivity was 69.5% with %42.6 gram-positive, 19.7% gram-negative, 3.8% polymicrobial gram-positive, 0.6% polymicrobial gram-negative, 0.6% polymicrobial mixed, 1.3% fungal and 0.6% anaerobic organisms. Coagulase-negative staphylococcus was the most common cause, accounting for 17.1% of all episodes.The mean number of peritonitis episodes was 3±2.3 in 42 patients with double-cuffed swan neck catheter whereas the number of peritonitis episodes was 2.3±1.6 in 13 patients with double-cuffed tenckhoff catheter. There was no relation between catheter type and the number of peritonitis episodes (p>0.05). DISCUSSION and CONCLUSION: In conclusion, neither the dialysis modality, catheter type, nor the catheter insertion techniques have a definite effect on the development of a perionitis episode. This directs us to consider the importantance of the training program given to the caregivers.

Keywords:

chronic, peritoneal, dialysis, peritonitis,

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