Clinical and bacteriological profile and antibiotic sensitivity pattern in spontaneous bacterial peritonitis among children with idiopathic nephrotic syndrome

Authors

  • Romana Akbar Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Ranjit Ranjan Roy Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Shanjida Sharmim Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • M. Asif Ali Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20243470

Keywords:

Spontaneous bacterial peritonitis, Idiopathic NS, Antibiotic sensitivity pattern, BSMMU

Abstract

Background: Spontaneous bacterial peritonitis is a serious complication of childhood nephrotic syndrome (NS). A precise knowledge of organism causing peritonitis is important primarily to treat infection and decrease morbidity, prevent antibiotic resistance and finally to reduce mortality. Objectives were to observe the clinical and bacteriological profile and antibiotic sensitivity pattern of peritonitis in childhood NS.

Methods: This cross-sectional observational study was conducted in pediatric nephrology department of Bangabandhu Sheikh Mujib medical university (BSMMU). The 44 diagnosed patient of spontaneous bacterial peritonitis among childhood idiopathic NS were enrolled as cases. The peritoneal fluid was obtained following standard procedure and examined for gross appearance, cytogical and biochemical analysis, microscopic examination with gram stain and peritoneal fluid culture along with antibiotic sensitivity.

Results: All patients had complaints of abdominal pain followed by fever, vomiting, lethargy and anorexia. All cases had edema and ascites followed by abdominal tenderness, abdominal wall rigidity, rebound tenderness and cellulitis in areas other than abdominal wall. Peritoneal fluid showed neutrophilic pleocytosis and exudative fluid. We observed 27.27% gram + cocci, 6.82% gram-bacilli in gram stain examination. Here, only 6.9% cases showed positive growth including 2.3% E. coli, 2.3% Pseudomonas, 2.3% Acinetobacter and remaining 93.1% cases showed no growth. We also described the antibiotic sensitivity pattern in this study.

Conclusions: In our study, patients predominantly had abdominal pain, fever, edema, ascites and abdominal tenderness. We found only 6.9% cases showed positive growth which included E. coli, Pseudomonas and Acinetobacter and demonstrated the antibiotic sensitivity and resistance pattern for these organisms.

References

Eddy AA, Symons JM. Nephrotic syndrome in childhood. The lancet. 2003;362(9384):629-39.

Lora SS, Choudhary R, Shekhawat YS, Gothwal S, Verma SK. Spectrum of Infections in Children with Primary Nephrotic Syndrome: Cross Sectional Study. J Pediatr Nephrol. 2021;9(1):10.

Rahman MH, Jesmin T, Muinuddin G. An update of Management of idiopathic nephrotic syndrome: a review article. Bangladesh Journal of Child Health. 2013;37(2):102-21.

Alpana O, Richa P, Vinit P, Uma A. Clinical spectrum of severe infections in nephrotic syndrome at a tertiary care hospital, Mumbai. International J. Healthcare Biomedical Research. 2017;5(02):8-18.

Iijima K, Swiatecka-Urban A, Niaudet P, Bagga A. Steroid-Sensitive Nephrotic Syndrome. In: Emma F, Goldstein SL, Bagga A, Bates CM, Shroff R, editors. Paediatric Nephrology. 8th ed. Switzerland. 2022;352.

Kumar M, Ghunawat J, Saikia D, Manchanda V. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. Braz J Nephrol. 2019;41(4):526-33.

Noone DG, Iijima K, Parekh R. Idiopathic nephrotic syndrome in children. The Lancet. 2018;392(10141):61-74.

Roy RR, Sultana N, Jesmin T, Al Mamun A, Kakon KK, Akbar R, et al. Steroid-Resistant Nephrotic Syndrome in Children: Clinicohistology and Pattern of Response to Immunosuppressive. Paediatr Nephrol J Bangl. 2023;8(1):7-23.

Teo S, Walker A, Steer A. Spontaneous bacterial peritonitis as a presenting feature of nephrotic syndrome. Journal of Paediatrics & Child Health. 2013 Dec 1;49(12).https://onlinelibrary.wiley.com/doi/10.1111/jpc.12389

Rashid JU, Mehmood RA, Ahmad JA, Anwar S, Bhatti MT. Frequency of peritonitis in children with nephrotic syndrome. Pak J Med Health Sci. 2009;3:177-80.

Sen S, Lalitha MK, Fenn AS, Mammen KE. Primary peritonitis in children. Anna Trop Paediatr. 1983;3(2):53-6.

Ajayan P, Krishnamurthy S, Biswal N, Mandal J. Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome. Indian Pediatr. 2013;50:779-81.

Speck WT, Dresdale SS, McMillan RW. Primary peritonitis and the nephrotic syndrome. Am J Surg. 1974;127(3):267-9.

Krensky AM, Ingelfinger JR, Grupe WE. Peritonitis in childhood nephrotic syndrome: 1970-1980. Am J Diseases Children. 1982;136(8):732-6.

Gorensek MJ, Lebel MH, Nelson JD. Peritonitis in children with nephrotic syndrome. Pediatrics. 1988;81(6):849-56.

Feinstein EI, Chesney RW, Zelikovic I. Peritonitis in childhood renal disease. Am J Nephrol. 1988;8(2):147-65.

Hingorani SR, Weiss NS, Watkins SL. Predictors of peritonitis in children with nephrotic syndrome. Pediatr Nephrol. 2002;17:678-82.

Matsell DG, Wyatt RJ. The role of I and B in peritonitis associated with the nephrotic syndrome of childhood. Pediatric research. 1993;34(1):84-7.

Fodor P, Saitúa MT, Rodriguez E, González B, Schlesinger L. T-cell dysfunction in minimal-change nephrotic syndrome of childhood. Am J Dis Children. 1982;136(8):713-7.

Heslan JM, Lautie JP, Intrator L, Blanc C, Lagrue G, Sobel AT. Impaired IgG synthesis in patients with the nephrotic syndrome. Clinical Nephrology. 1982;18(3):144-7.

Akalin HE, Fisher KA, Laleli Y, Caglar S. Bactericidal activity of ascitic fluid in patients with nephrotic syndrome. Europ J Clin Investigation. 1985;15(3):138-40.

Ackerman Z. Ascites in nephrotic syndrome: incidence, patients' characteristics, and complications. J Clin Gastroenterol. 1996;22(1):31-4.

Iqbal SM, Sarfaraz M, Azhar I, Ahmad T. The Incidence and Organisms Causing Spontaneous Peritonitis in Children With Nephrotic Syndrome. Ann King Edward Medical University. 2002;8(3):1.

Wen JW, Liacouras CA. Peritonitis. In: Kliegman RM, ST Geme JW, Blum NJ, Tasker RC, Wilson KM, Schuh AM, Mack CL, editors. Nelson Textbook of Paediatrics. 22nd ed. New York, NY: Elsevier; 2024;2510-12.

Krishnan C, Rajesh TV, Shashidhara HJ, Jayakrishnan MP, Geeta MG. Major infections in children with nephrotic syndrome. Int J Contemp Pediatr. 2017;4(2):346-50.

Srivastava RN, Bagga A. Pediatric Nephrology. 5th ed. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2011. Chapter 11, Nephrotic Syndrome. 2011;195-234.

Speck WT, Dresdale SS, McMillan RW. Primary peritonitis and the nephrotic syndrome. Am Surg. 1974;127(3):267-9.

Senguttuvan P, Ravanan K, Prabhu N, Tamilarasi V. Infections encountered in childhood nephrotics in a pediatric renal unit. Indian J Nephrol. 2004;14(3):85-8.

Mohammed DY, Selim MS, Zeid AM, Neemat-Allah MA. Rate and Type of Infections in Children with Nephrotic Syndrome. Arch Clin Med Case Reps. 2018;2(2):31-9.

Lebel A, Kropach N, Ashkenazi-Hoffnung L, Huber-Yaron A, Davidovits M. Infections in children with nephrotic syndrome: twenty years of experience. Clin Pediatr. 2020;59(7):692-8.

Ashiru-Oredope D, Susan Hopkins on behalf of the English Surveillance Programme for Antimicrobial Utilization and Resistance Oversight Group, Kessel A, Hopkins S, Ashiru-Oredope D, Brown B et al. Antimicrobial stewardship: English surveillance programme for antimicrobial utilization and resistance (ESPAUR). J Antimicrob Chemoth. 2013;68(11):2421-3.

Frieden T. Antibiotic resistance threats in the United States. Centers Dis Control Prev. 2013;114.

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. The Lancet infectious diseases. 2013;13(12):1057-98.

Islam SS, Malek MA, Haque AF, Talukder KA, Akhter MZ. Beta lactamase genes of extended spectrum beta lactamase producing Escherichia coli from anorectal sepsis cases in Bangladesh. Bangl J Microbiol. 2013;30(1-2):23-9.

Safain KS, Bhuyan GS, Tasnim S, Hasib SH, Sultana R, Islam MS, et al. Situation of antibiotic resistance in Bangladesh and its association with resistance genes for horizontal transfer. BioRxiv. 2020;2020-04

Gulati S, Kher V, Gupta A, Arora P, Rai PK, Sharma RK. Spectrum of infections in Indian children with nephrotic syndrome. Pediatr Nephrol. 1995;9:431-4.

Uncu N, Bülbül M, Yıldız N, Noyan A, Koşan C, Kavukçu S, et al. Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study. Eur J Pediatr. 2010;169:73-6.

International Study of Kidney Disease in Children. Minimal Change Nephrotic Syndrome in Children: Deaths During the First 5 to 15 years’ Observation. Report of the International Study of Kidney Disease in Children. J Urol. 1984;132(3):624.

Katz CM, Katz SL. Etiology of bacterial sepsis in nephrotic children 1963-1967. Pediatrics. 1968;42(5):840-3.

Suzanne V, Diarmid MC. Treatment of end stage liver disease. In: Walker WA, D Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB. Pediatric Gastointestinal Disease: Pathophisiology, Diagnosis, Management. 4th ed. Philadelphia: Saunders; 2004;1520.

Tain YL, Lin G, Cher TW. Microbiological spectrum of septicemia and peritonitis in nephrotic children. Pediatr Nephrol. 1999;13(9):835-7.

Downloads

Published

2024-11-25

Issue

Section

Original Research Articles