Kim G C, Korbet S M
Department of Medicine, Section of Nephrology, Rush-Presbyterian St Luke's Medical Center, Chicago, IL, USA.
Am J Kidney Dis. 2000 Nov;36(5):1000-8. doi: 10.1053/ajkd.2000.19102.
We retrospectively evaluated 232 continuous ambulatory peritoneal dialysis (CAPD) patients entering our program from January 1, 1987, to December 31, 1997, for polymicrobial peritonitis. Polymicrobial peritonitis occurred in 16% of the patients (polymicrobial-peritonitis group), whereas 52% of the patients had peritonitis episodes with only a single organism (single-organism group), and 32% of the patients had no episode of peritonitis. Polymicrobial peritonitis accounted for 8% of the 554 peritonitis episodes, occurred after 23 +/- 20 months on peritoneal dialysis (PD), and was preceded by greater than three episodes of peritonitis in 73% of the patients. Peritonitis rates were greater in the polymicrobial-peritonitis group compared with patients in the single-organism group (1.8 versus 1.2 episodes/patient-year; P: < 0.001). The majority of polymicrobial infections involved gram-negative and/or fungal pathogens, but in 21% of the episodes, only gram-positive organisms were identified. An intra-abdominal process was identified in only 7% of the patients. Catheter loss overall was greatest in the polymicrobial-peritonitis group (65% versus single-organism group, 30% versus patients without peritonitis, 5%; P < 0.001), but only 33% of the polymicrobial infections resulted in catheter loss. At last follow-up, 70% of the patients in the polymicrobial-peritonitis group had permanently transferred to hemodialysis compared with 25% from the single-organism group and 15% from the no-peritonitis group (P < 0.001). In conclusion, polymicrobial peritonitis is an infrequent but serious complication of CAPD that occurs late in the course of PD and is often preceded by recurrent episodes of peritonitis. Polymicrobial peritonitis is rarely the result of a catastrophic intra-abdominal process, and although the majority of patients can be successfully treated without catheter removal, the long-term prognosis is poor, with a high rate of transfer to hemodialysis.
我们回顾性评估了1987年1月1日至1997年12月31日期间进入我们项目的232例持续性非卧床腹膜透析（CAPD）患者的多微生物性腹膜炎情况。16%的患者发生了多微生物性腹膜炎（多微生物性腹膜炎组），而52%的患者腹膜炎发作仅由单一微生物引起（单一微生物组），32%的患者未发生腹膜炎发作。多微生物性腹膜炎占554例腹膜炎发作的8%，发生在腹膜透析（PD）23±20个月后，73%的患者在发生多微生物性腹膜炎之前有超过三次的腹膜炎发作。多微生物性腹膜炎组的腹膜炎发生率高于单一微生物组的患者（1.8次/患者年对1.2次/患者年；P：<0.001）。大多数多微生物感染涉及革兰氏阴性菌和/或真菌病原体，但在21%的发作中，仅鉴定出革兰氏阳性菌。仅7%的患者发现有腹腔内病变。多微生物性腹膜炎组的导管丢失总体上最为严重（65%，单一微生物组为30%，无腹膜炎患者为5%；P<0.001），但仅33%的多微生物感染导致导管丢失。在最后一次随访时，多微生物性腹膜炎组70%的患者已永久转为血液透析，单一微生物组为25%，无腹膜炎组为15%（P<0.001）。总之，多微生物性腹膜炎是CAPD一种不常见但严重的并发症，发生在PD病程后期，且常先有腹膜炎反复发作。多微生物性腹膜炎很少是由灾难性腹腔内病变引起的，虽然大多数患者无需拔除导管即可成功治疗，但长期预后较差，转为血液透析的比例较高。
