Korean Journal of Nephrology 1991;10(3):379-386.

소아 CAPD에서의 복막염

구자욱 , 하태선 , 임인석 , 하일수 , 정해일 , 최용 , 고광욱

Abstract

A retrospective analysis of peritonitis experiments in 24 ESRD patients with a mean age of 8.6 years, who underwent CAPD at the Pediatric Department of Seoul national University Hospital from Feb. 1987 to Aug. 1990, were performed. And the results were as follows: 1) A total of 54 episodes of peritonitis occurred during 7,696 patient-days of CAPD in 20 of the 24 patients with the incidence of peritonitis at 2.6 patient-year (1 per 4.8 patient-month). The incidence of peritonitis has declined progressively during past 4 years except 1989: 4.0 epi- sodes per patient-year in 1987, 2.6 in 1988, 3.0 in 1989, and 1.4 in 1990. 2) The first episode of peritonitis was occurred within one week of beginning CAPD in 15% within 4 weeks in 45%, within 6 months in 809. And within 1 years in 100% of those who experienced peritonitis. 3} The rate of positive and negative culture were 59. 8%. (32/54) and 37.0% (20/54), respectively. Gram posi- tive organisms were cultured in 56.3% (18/32), gram negative organisms in 21.8%. (7/32), CNS (28.1%, 9/32) and S.aureus (21.9%., 7/32) were most prevalent organ- isms. 4) Peritonitis were responsible for 20.9 days of hospi- talization per patient-year. Peritonitis was successfully treated in outpatient basis only 33.3% and by antibiotics only in 85.2%. The remaining 8 (14%.) patients needed to remove the catheters for the treatment. 5) A total of 14 episodes (44% of all catheters) of pericathet er infection (including exit-site and tunnel infection) occurred during same period. In 57.2% (8/14) of these infections peritonitis followed. 6) Peritoneal catheters had to be removed in 17 epi- sodes excluding of 5 episodes due to death and renal transplantation: in 8 episodes because of peritonitis. 7) A total of 32 peritoneal catheters were implanted. Mean surviaval of all catheters was 9.2 months. The actuarial catheter survival by Kaplan-Meier method was 58.6 % and 35.4% at 6 and 12 months, respectively. In conclusion, the future of CAPD as a long term therapeutic modality depends on peritonits. Therefore, new approaches to the prevention and the treatment CAPD peritonitis should be evaluated. If infection can be successfully managed and prevented, CAPD promised to become increasingly popular for treatment of end stage renal disease.