1
|
AlZabli SM, Alsuhaibani MA, BinThunian MA, Alshahrani DA, Al Anazi A, Varghese S, Rose V, Rahim KA. Peritonitis in children on peritoneal dialysis: 12 years of tertiary center experience. Int J Pediatr Adolesc Med 2021; 8:229-235. [PMID: 34401447 PMCID: PMC8356114 DOI: 10.1016/j.ijpam.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 10/27/2022]
Abstract
Background and Objective Peritoneal dialysis (PD) associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients undergoing PD. We aimed to identify the incidence, pathogens, antibiotic susceptibility, and the outcome of peritoneal dialysis (PD)-associated peritonitis in children. Methods Data from medical records of children who underwent PD between 2007 and 2018 in King Fahad Medical City were retrospectively collected. All children aged <14 years undergoing chronic PD were included. The demographic characteristics of patients, peritonitis rates, and clinical outcomes were collected. Results In total, 131 children [boys, 68 (51.9%)] underwent automated PD for 305 years. The most common age group was 6-12 years (61 patients, 46.6%). A total of 74.0% of patients were new to dialysis; 25.2% were transferred from hemodialysis. Peritonitis incidence was 0.6 episodes/patient-year. Gram-positive and -negative organisms were identified in 50.1% and 22% episodes, respectively, whereas cultures remained negative in 20.5% episodes. Coagulase-negative Staphylococcus was the most common isolated organism (22.1%), followed by methicillin-sensitive S. aureus (11.1%). Peritonitis was resolved in 153 (73.6%) episodes, whereas 52 (25.0%) episodes required removal through the catheter. The multivariate logistic regression analysis found the exit site infection to be a risk factor for catheter removal. Three (1.4%) episodes caused death due to peritonitis complicated by septic shock. Conclusions Our data showed that the most common organisms causing peritonitis were similar to those reported in the previous international registry. The rate of peritonitis was high, but markedly improved in the past two years.
Collapse
Affiliation(s)
- Saeed M AlZabli
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Mohammed A Alsuhaibani
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, 51452, Saudi Arabia
| | - Meshail A BinThunian
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Dayel A Alshahrani
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Abdulkarim Al Anazi
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Sibi Varghese
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Vernice Rose
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Khawla A Rahim
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| |
Collapse
|
2
|
Alsuhaibani M, Aldosari E, Rahim KA, Alzabli S, Alshahrani D. Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre. BMC Nephrol 2020; 21:400. [PMID: 32938414 PMCID: PMC7493397 DOI: 10.1186/s12882-020-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia. METHODS In this case-control study, the medical records and laboratory results of paediatric patients aged 0-14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio). RESULTS A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole. CONCLUSIONS This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.
Collapse
Affiliation(s)
- Mohammed Alsuhaibani
- Department of Paediatrics, College of Medicine, Qassim University, P.O. Box 6666, Buraidah, Qassim, 51452, Saudi Arabia. .,Department of Paediatric Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Egab Aldosari
- General Paediatric Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khawla A Rahim
- Department of Paediatric Nephrology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saeed Alzabli
- Department of Paediatric Nephrology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dayel Alshahrani
- Department of Paediatric Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Yinnon AM, Gabay D, Raveh D, Schlesinger Y, Slotki I, Attias D, Rudensky B. Comparison of Peritoneal Fluid Culture Results from Adults and Children Undergoing Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089901900109] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities. Objective To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities. Design Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD. Results We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2 ± 3.5, range 1 – 15) compared to 187 in adults (2.1 ± 1.9, range 1 – 10) ( p < 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) ( p < 0.001). The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8 ± 2.3, range 1 – 12; and 5.3 ± 5.2, range 1 – 27) than in adults (2.0 ± 1.3, range 1 – 6; and 2.7 ± 2.4, range 1 – 10) ( p < 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children ( p < 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults ( p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children ( p < 0.01), whereas S. aureus occurred more often in adults ( p < 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults ( p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults ( p < 0.05 – 0.001). Conclusions CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
Collapse
Affiliation(s)
- Amos M. Yinnon
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Dorit Gabay
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - David Raveh
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Yechiel Schlesinger
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Itzchak Slotki
- Nephrology Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Denise Attias
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Bernard Rudensky
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
4
|
Müller-Wiefel DE. Treatment of Peritonitis in Pediatric Continuous Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
5
|
Rusthoven E, Monnens LA, Schröder CH. Effective Treatment of Peritoneal Dialysis-Associated Peritonitis with Cefazolin and Ceftazidime in Children. Perit Dial Int 2020. [DOI: 10.1177/089686080102100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the use of the combination of cefazolin and ceftazidime for initial treatment of peritoneal dialysis (PD)-related peritonitis in pediatric patients. Design Retrospective nonrandomized study. Setting Pediatric dialysis units of the University Medical Center of Utrecht and Nijmegen, The Netherlands. Patients 40 children (median age 5.4 years) who were treated with PD during the study period of 4.5 years. Interventions All 50 episodes of peritonitis that occurred during the study period were evaluated by review of medical records. Patients were given intraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L and cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were continued for 14 days. Results After identification of the causative microorganism, one of the antibiotics was discontinued in 34 cases, and the antibiotic schedule was adapted in 2 cases. All cases were initially cured within 3 days. In 5 cases (10%), there was a peritonitis with the same organism recurring within 2 weeks after completion of treatment. There were 4 cases of PD-related peritonitis caused by pseudomonas, all of which were cured. Conclusions The antibiotic combination of cefazolin and ceftazidime is effective for the initial therapy of PD-related peritonitis in children. The toxic complications of aminoglycosides are avoided with this combination.
Collapse
Affiliation(s)
- Esther Rusthoven
- Department of Pediatrics, Wilhelmina Children's University Hospital, Utrecht; Department of Pediatrics, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Leo A.H. Monnens
- Department of Pediatrics, Wilhelmina Children's University Hospital, Utrecht; Department of Pediatrics, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Cornelis H. Schröder
- Department of Pediatrics, Wilhelmina Children's University Hospital, Utrecht; Department of Pediatrics, University Medical Center Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Al Mokali K, Al Sannaa Z, Al Mutairi F, Ahmed AE. Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis. BMC Pediatr 2020; 20:42. [PMID: 31996157 PMCID: PMC6988221 DOI: 10.1186/s12887-020-1936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background The peritonitis rate among children treated with peritoneal dialysis (PD) has not been widely reported in Saudi Arabia. The study aim was to estimate the peritonitis rate per patient-year and investigate the factors associated with higher peritonitis rates in a sample of PD children at King Abdullah Specialist Children’s Hospital-Riyadh (KASCH-R), Saudi Arabia. Methods This retrospective cohort study included 27 PD children treated between September 2007 and December 2017 at KASCH-R. We recorded the children’s demographic and clinical data, and the frequency of peritonitis. Results The 27 PD children reviewed (63% girls; mean age = 7.32 years old; range, 1–14 years), resulted in 86 peritonitis diagnoses in which the overall recurrence rate (in at least one episode) was 58/86 (67.4%) with a 95% confidence interval (CI), 56.5 to 77.2%. The rate of peritonitis episodes per patient-year was 0.76 (1 episode per 1.31 patient-year). The generalized Poisson model identified older children (age > 10 years) (adjusted rate ratios [aRR] = 7.273, 95% CI: 1.562–33.860), congenital nephrosis (aRR = 4.677, 95% CI: 1.443–15.155), height below 3rd percentile (aRR = 4.689, 95% CI: 1.874–11.735), weight below 3rd percentile (aRR = 5.388, 95% CI: 1.678–17.302), low albumin level (aRR = 4.041, 95% CI: 2.053–7.956), two-week duration of antibiotic therapy (aRR = 2.947, 95% CI: 1.163–7.468), which were independently associated with a high peritonitis rate. Conclusions This study showed a high peritonitis rate in our center. Older children, congenital nephrosis, height and weight below the 3rd percentile, low albumin level, and long duration of antibiotic therapy were associated with a higher rate of peritonitis. An optimal peritonitis prevention strategy or best-practice guideline is needed to reduce and prevent peritonitis occurrence in our center.
Collapse
Affiliation(s)
- Khamisa Al Mokali
- Division of Nephrology, Department of Paediatrics, King Abdullah Specialist Children's Hospital, Ministry of the National Guard - Health Affairs City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Faten Al Mutairi
- Maternity and Children Hospital, Madina Al Munawara, Saudi Arabia
| | - Anwar E Ahmed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. .,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| |
Collapse
|
7
|
Jellouli M, Ferjani M, Abidi K, Hammi Y, Boutiba I, Naija O, Zarrouk C, Ben Abdallah T, Gargah T. [Peritonitis in pediatric patients receiving peritoneal dialysis]. Nephrol Ther 2015; 11:558-63. [PMID: 26520233 DOI: 10.1016/j.nephro.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. METHODS In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. RESULTS Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. CONCLUSION Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.
Collapse
Affiliation(s)
- Manel Jellouli
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie.
| | - Meriem Ferjani
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Kamel Abidi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Yosra Hammi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ilhem Boutiba
- Service de bactériologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ouns Naija
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Chokri Zarrouk
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de médecine interne et de néphrologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Tahar Gargah
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| |
Collapse
|
8
|
Nakwan N, Dissaneewate P, Lim A, Vachvanichsanong P. Peritoneal dialysis-related peritonitis in southern Thailand. Int J Artif Organs 2008; 31:49-54. [PMID: 18286454 DOI: 10.1177/039139880803100107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate peritonitis in children receiving peritoneal dialysis (PD) in southern Thailand. PATIENTS AND METHODS We reviewed the records of patients who received PD at the Department of Pediatrics, Prince of Songkla University from January 1994 to December 2003. RESULTS Forty-six patients had PD performed for 228.6 patient-months. Their mean age was 9.5+/-4.8 years (range 3.0 months-16.7 years). Twenty-eight patients had complications with 61 episodes of peritonitis. The age, sex and causes of renal failure did not display any differences between patients who had or did not have peritonitis (p=0.2, 0.6 and 0.6, respectively). The first peritonitis occurrence was on average at 2.7+/-4.0 patient-months (median 0.4, range 0-12.5) following catheter insertion, with an average incidence rate of one infection per 3.5+/-4.8 patientmonths (median 1.0, range 0-23.2). The causative agents were both gram-positive and gram negative bacteria, and fungi at 24%, 44%, and 8% respectively (24% of the cultures did not grow). There was no significant difference in causative agents between home- and hospital-acquired peritonitis (p=1.0). CONCLUSION PD-related peritonitis in this study occurred earlier and more often than in other studies, probably because all of our PDs were performed immediately after catheter insertion.
Collapse
Affiliation(s)
- N Nakwan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai - Thailand
| | | | | | | |
Collapse
|
9
|
Grünberg J, Verocay MC, Rébori A, Ramela V, Amaral C, Hekimian G, Viera M, Pouso J. Twenty years' pediatric chronic peritoneal dialysis in Uruguay: patient and technique survival. Pediatr Nephrol 2005; 20:1315-9. [PMID: 15942784 DOI: 10.1007/s00467-005-1939-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 03/04/2005] [Accepted: 03/04/2005] [Indexed: 11/30/2022]
Abstract
In this study we analyze the impact of the patient's socioeconomic status (SES) and the distance from the patient's home to the dialysis center (DPH-DC), classified as < or =300 km or >300 km, on the patient and technique survival of 59 patients starting chronic peritoneal dialysis (CPD) between May 1983 and January 2004 at a single center in Uruguay. SES was established using Graffar's method. Mean duration of CPD was 38.1+/-26.0 months. Mean age at the start of CPD was 8.4+/-5.2 years. Overall patient and technique survival at 5 years were 86.4% and 77.9%, respectively. Twenty (33.8%) patients were transferred to hemodialysis. Eight (13.5%) patients died. The incidence of peritonitis was one episode every 9.1 months. There was no statistically significant difference in patient and technique survival between the patients in the low and high SES groups (p=0.72 and 0.99, respectively), and between those in the two DPH-DC groups, (p=0.22 and p=0.99, respectively). Logistic regression analysis confirmed low SES and DPH-DC >300 km are not predictors of patient death (p=0.79 and p=0.09, respectively) or technical failure (p=0.35 and p=0.15, respectively). No SES- and DPH-DC-related statistically significant differences were found in patient and technique survival.
Collapse
Affiliation(s)
- Jose Grünberg
- Hospital Evangélico, Servicio de Nefrología de Niños y Adolescentes, Instituto de Medicina Altamente Especializada, Rambla Gandhi 221 ap 201, 11300 Montevideo, Uruguay.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Dorko E, Kmet'ová M, Marossy A, Dorko F, Molokácová M. Non-albicans Candida species isolated from plastic devices. Mycopathologia 1999; 148:117-22. [PMID: 11189762 DOI: 10.1023/a:1007178806720] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this work we point out an occurrence of non-albicans Candida species isolated from catheters, cannulas and drains. We detected eight non-albicans Candida species in 49 examined samples: C. parapsilosis (n = 26), C. tropicalis (n = 12), C. krusei (n = 4), C. claussenii, C. mesenterica (n = 2 for each), C. guilliermondii, C. kefyr and C. lusitaniae (n = 1 for each). Material examined from children hospitalized in intensive care units was the most frequent. Eight samples were from the oncology department, seven from the surgery department, six from the anaesthesiology department, four from the dialysis unit, two from the hematology department, one from the internal medicine department and one from the stomatology department. We examined cannula scraping 26 times (53%), catheter scraping 14 times (28.6%) and drain scraping nine times (18.4%).
Collapse
Affiliation(s)
- E Dorko
- Department of Physiology, Medical Faculty, Safarik's University, Kosice, Slovakia
| | | | | | | | | |
Collapse
|