Swartz R D, Messana J M
Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, USA.
Adv Perit Dial. 1999;15:205-8.
Problematic peritoneal dialysis infection is a major cause of catheter loss and interruption of peritoneal dialysis (PD) therapy. In selected instances, problematic infection can be successfully treated by removing and replacing the catheter while continuing with PD. Accumulated experience has helped to define the circumstances under which a removal/replacement procedure is likely to be safe and under which complications are likely to arise. It appears that simultaneous removal and replacement can be expected to succeed when problematic infection is associated with tunnel infection, with recurring peritonitis repetitively culturing the same organism but clearing between episodes, and with gram-positive organisms. Success is less likely in the presence of ongoing inflammation, of active infection, of gram-negative or fungal organisms, or of any evidence of intra-abdominal adhesions. We review the literature on which these criteria are based and conclude with updated recommendations.
有问题的腹膜透析感染是导致导管丢失和腹膜透析（PD）治疗中断的主要原因。在某些情况下，通过在继续进行腹膜透析的同时移除并更换导管，有问题的感染可以得到成功治疗。积累的经验有助于确定在哪些情况下移除/更换手术可能是安全的，以及在哪些情况下可能会出现并发症。当有问题的感染与隧道感染、反复培养出相同病原体且发作间期可清除的复发性腹膜炎以及革兰氏阳性菌相关时，同时移除和更换导管有望成功。在存在持续炎症、活动性感染、革兰氏阴性菌或真菌、或任何腹腔内粘连证据的情况下，成功的可能性较小。我们回顾了这些标准所依据的文献，并给出了更新后的建议。
