Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes

“…In the IPPR data, neither the combination of ceftazidime with a first-generation cephalosporin or a glycopeptide (vancomycin or teicoplanin) as initial empiric therapy of sporadic peritonitis was associated with an increased incidence of relapse [12]. However, the subsequent prescription of monotherapy with a first-generation cephalosporin based on culture and susceptibility results was associated with higher relapse rate (23 %) than monotherapy with any other single antibiotic (0-9 %).…”

“…As noted previously, an episode of peritonitis that occurs within 4 weeks of completion of therapy for an earlier episode that is attributable to the same organism, or one sterile episode, is characterized as relapsing peritonitis [11,12]. Relapsing [16,19].…”

“…However, a recent study comparing the outcomes of 181 episodes of repeat peritonitis (observed from 1995 to 2009) with 91 episodes of relapsing peritonitis showed that the two groups of peritonitis episodes have different patterns of causative organisms and therapeutic response, which implies that they are indeed two distinct entities [15]. Although there was a debate and confusion regarding the terminology and a correction was proposed [14], the definitions of relapsing, recurrent and repeat peritonitis were not changed and were fully endorsed in the 2010 update of the adult guidelines [11] and the 2012 update of the pediatric peritonitis guidelines [12]. In these same guidelines, it has also been recommended that relapsing episodes of peritonitis should not be counted as an additional episode when calculating peritonitis rates, in contrast to recurrent and repeat episodes which should be counted.…”

“…Two or more episodes of peritonitis can be characterized as either relapsing, recurrent or repeat [11,12]. An episode that occurs within 4 weeks of completion of therapy of a prior episode with the same organism or one sterile episode is defined as relapsing peritonitis.…”

“…Since, by definition, the bacterial etiology of relapsing peritonitis is the same as that of the preceding episode of peritonitis (except in the case of culture-negative peritonitis), it is prudent to empirically start the patient on an antibiotic that would treat the first organism identified based on the previously determined antibiotic susceptibilities whenever a new episode is diagnosed within 4 weeks of completion of therapy for a prior bout of peritonitis [12]. If the center-specific resistance rate of S. aureus isolates to methicillin or oxacillin exceeds 10 % or if the patient has a history of methicillinresistant S. aureus (MRSA), IP administration of a glycopeptide combined with an antibiotic providing Gram-negative coverage should characterize the empiric treatment of any potential relapsing peritonitis episode, as is the case with an initial bout of peritonitis [12]. Treatment should be tailored once the new susceptibility pattern is identified.…”