Microbiological spectrum of septicemia and peritonitis in nephrotic children

Abstract

From April 1993 to December 1997, 452 admissions of 231 children with nephrotic syndrome to Chang Gung Children's Hospital were retrospectively reviewed. There were 10 episodes of sepsis and 8 episodes of peritonitis in 18 children, and 14 microorganisms were cultured. Two children died due to Streptococcus pneumoniae sepsis. Gram-positive microorganisms (n=7) and Gram-negative microorganisms (n=7) were found in equal numbers. Enterococcus (1), Streptococcus pneumoniae (4), group D streptococcus (1), and Streptococcus viridans (1) were the Gram-positive microorganisms cultured. Two of 4 cases of Streptococcus pneumoniae sepsis were penicillin resistant. Gram-negative microorganisms included Enterobacter cloacae (1), Klebsiella pneumoniae (1), Escherichia coli (2), Acinetobacter baumannii (1), Neisseria meningitidis (1), and group B salmonella (1). The last three microorganisms have not been previously associated with nephrotic children. Vancomycin therapy to cover penicillin-resistant Streptococcus pneumoniae and a third-generation cephalosporin therapy to cover rare Gram-negative microorganisms should be considered in serious infections of nephrotic children.

Major infections in children with nephrotic syndrome

“…24 Peritonitis due to penicillin resistant pneumococci are increasingly reported in children with nephrotic syndrome. 18 Both pneumococcal isolates were resistant to penicillin in our study. The E coli isolate was multidrug resistant.…”

“…Chang-ching wei et al and Tain YL also had similar findings in their studies. 10,17,18 MRSA and CONS, the causative agents of septicemia in present study were not the frequently reported pathogens in nephrotic syndrome. In the study by Ajeyan et al, MRSA was isolated in 2 children.…”

Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study

“…The infectious complications, especially primary peritonitis, are well-known alarming situation in children with nephrotic syndrome (NS) [3,6,7,17,18]. Peritonitis has been reported with an incidence of 1.5-16% in nephrotic children [3,4,6,17,18].…”

Development of Purulent Meningitis in a Child With Nephrotic Syndrome While Receiving Cephtriaxone Plus Amikacin

“…There is a tendency to development of infections, especially caused by capsulated bacteriae like S. pneumoniae and H. influenzae, in nephrotic patients due to various risk factors including reduced immunoglobulin concentration via urinary loss of IgG, depletion of properdin factor B, the deleterious effects of edematous tissue resembling culture medium, decreased bactericidal activity of leukocytes by immunosuppressive therapy and inefficient perfusion of spleen due to hypovolemia (1)(2)(3)(4). Case history, clinical and laboratory evaluation and 4 year-follow up of our patient disclosed a tendency to development of infections particularly peritonitis.…”

“…Several factors may explain the tendency of nephrotic children to develop bacterial infections: low IgG levels due to impaired synthesis or urinary loss, urinary loss of Factor B and impaired cellular immunity (1,2).…”