소아 복막 투석 환자에서 발생한 복막염의 경험적 항생제 치료에 관한 연구
Peritoneal Dialysis Associated Peritonitis and Empirical Antibiotics Therapy in Korean Children with Chronic Renal Failure
0
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06±15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2 %), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.
Abstract
Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06±15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2 %), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.
참고문헌 (30)
- Ates K, "The longitudinal effect of a single peritonitis episode on peritoneal membrane transport in CAPD patients", Perit Dial Int, 20, pp.220~206 (2000)
- Choi P, "Peritoneal dialysis catheter removal for acute peritonitis: a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization", Am J Kidney Dis, 43, pp.103~111 (2004)
- Coles GA, "Long-term peritoneal membrane changes", Adv Ren Replace Ther, 7, pp.289~301 (2000)
- Davies SJ, "Longitudinal changes in peritoneal kinetics: the effects of peritoneal dialysis and peritonitis", Nephrol Dial Transplant, 11, pp.498~506 (1996)
- Fried LF, "Peritonitis influences mortality in peritoneal dialysis patients", J Am Soc Nephrol, 7, pp.2176~2182 (1996)
- Kawanishi H, "Successful surgical management of encapsulating peritoneal sclerosis", Perit Dial Int, 25(4), pp.S39~S47 (2005)
- Rigby RJ, "Sclerosing peritonitis: the experience in Australia", Nephrol Dial Transplant, 13, pp.154~159 (1998)
- Piraino B, "Peritoneal dialysis-related infections recommendations: 2005 update", Perit Dial Int, 25, pp.107~131 (2005)
- Feneberg R, "The international pediatric peritonitis registry: a global Internet-based initiative in pediatric dialysis", Perit Dial Int, 25(3), pp.S130~S134 (2005)
- Fey PD, "Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus", Antimicrob Agents Chemother, 47, pp.196~203 (2003)
- Daum RS, "A novel methicillin-resistance cassette in community-acquired methicillin-resistant Staphylococcus aureus isolates of diverse genetic backgrounds", J Infect Dis, 186, pp.1344~1347 (2002)
- Kim HB, "In vitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary-care hospitals in Korea: a nationwide survey", Antimicrob Agents Chemother, 48, pp.1124~1127 (2004)
- Chong Y, "Present situation of antimicrobial resistance in Korea", J Infect Chemothe, 6, pp.189~195 (2000)
- Teitelbaum I., "Vancomycin for the initial therapy of peritonitis: don't throw out the baby with the bathwater", Perit Dial Int, 21, pp.235~238 (2001)
- Van Biesen W, "The need for a center-tailored treatment protocol for peritonitis", Perit Dial Int, 18, pp.274~281 (1998)
- Van Biesen W, "Peritoneal-dialysis-related peritonitis: the art of rope-dancing", Nephrol Dial Transplant, 17, pp.1878~1882 (2002)
- Goldberg L, "Initial treatment of peritoneal dialysis peritonitis without vancomycin with a once-daily cefazolin-based regimen", Am J Kidney Dis, 37, pp.49~55 (2001)
- Vas S, "Treatment in PD patients of peritonitis caused by gram-positive organisms with single daily dose of antibiotics", Perit Dial Int, 17, pp.91~94 (1997)
- Zelenitsky S, "Analysis of microbiological trends in peritoneal dialysis-related peritonitis from 1991 to 1998", Am J Kidney Dis, 36, pp.1009~10113 (2000)
- Krishnan M, "Predictors of outcome following bacterial peritonitis in peritoneal dialysis", Perit Dial Int, 22, pp.573~581 (2002)
- Warady BA, "Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis", Perit Dial Int, 20, pp.610~624 (2000)
- Millikin SP, "Antimicrobial treatment of peritonitis associated with continuous ambulatory peritoneal dialysis", Perit Dial Int, 11, pp.252~260 (1991)
- Muller-Wiefel DE, "Treatment of peritonitis in pediatric continuous peritoneal dialysis", Perit Dial Int, (2), pp.S450~S45 (1999)
- Schaefer F, "Intermittent versus continuous intraperitoneal glycopeptide", ceftazidime treatment in children with peritoneal dialysis- associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS), 1999, pp.10, 136~145
- Staphylococcus aureus resistant to vancomycin--United States, , MMWR Morb Mortal Wkly Rep, 51, pp.565~567 (2002)
- Vancomycin-resistant Staphylococcus aureus, , MMWR Morb Mortal Wkly Rep, 53, pp.322~323 (2004)
- Vancomycin-resistant Staphylococcus aureus, , MMWR Morb Mortal Wkly Rep, 51, pp.902~ (2002)
- Zurowska A, "Peritonitis in children treated with automated peritoneal dialysis", Pol Merkur Lekarski, 10, pp.216~218 (2001)
- Negoi D, "Automated peritoneal dialysis - indications and management", Contrib Nephrol, 150, pp.278~284 (2006)
- Chiu MC, "Peritonitis and exit-site infection in pediatric automated peritoneal dialysis", Perit Dial Int, 28, pp.S179~S182 (2008)