Kronik Periton Diyalizi Uygulanan Çocuklarda Peritonitlerin Değerlendirilmesi; Tek Merkez Deneyimi

Yıl 2019, Cilt: 17 Sayı: 1, 140 - 150, 01.04.2019

Osman Dönmez Berfin Uysal Okan Akacı Mercan Çelenk

Öz

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

Öz

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.

Anahtar Kelimeler

chronic, peritoneal, dialysis, peritonitis

Kaynakça

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