Exit-site infection in children on peritoneal dialysis: comparison of two types of peritoneal catheters.

摘要

OBJECTIVE: To review our experience with two types of peritoneal catheters, the standard Tenckhoff catheter and the swan-neck presternal catheter (SNPC). DESIGN: A retrospective study was undertaken to compare exit-site infection (ESI) rates using two types of peritoneal catheters in children. SETTING: Medical University of Warsaw, Warsaw, Poland. PATIENTS: During the past 10 years, 60 peritoneal catheters were implanted in 50 children with end-stage renal failure: 46 straight, double-cuffed Tenckhoff in 37 children (mean age 11.8 +/- 4.2 years, range 3.1 - 18.5 years), and 14 presternal in 13 children (mean age 10.6 +/- 5 years, range 0.3-17.7 years). The SNPCs were used in special clinical situations such as recurrent ESI with previous abdominal peritoneal catheters, obesity, presence of ureterocutaneostomies, use of diapers, and young age. For the statistical analysis, only the first catheter placed in each child was chosen: 34 standard Tenckhoff catheters and 9 SNPCs. INTERVENTION: In all children,peritoneal catheters were implanted surgically under general anesthesia by one surgeon; uniform operative technique and perioperative management was used. RESULTS: The mean observation time for 46 standard Tenckhoff catheters was 23.8 +/- 21.1 months, and for 14 SNPCs 25.1 +/- 27.0 months. The ESI rate was 1/17.4 patient-months (0.69 episodes/year) for Tenckhoff catheters and 1/70.2 patient-months (0.17 episodes/year) for SNPCs. The observed differences in ESI rates between the groups reported did not achieve statistical significance. CONCLUSIONS: The risk of ESI may be lower with presternal catheters. Confirmation of these findings requires further prospective clinical investigation in large numbers of patients.