Goldberg L, Clemenger M, Azadian B, Brown E A
Departments of Renal Medicine and Medical Microbiology, Imperial College School of Medicine, Charing Cross Hospital, London, UK.
Am J Kidney Dis. 2001 Jan;37(1):49-55. doi: 10.1053/ajkd.2001.20581.
To reduce the use of vancomycin, the current recommendations of the International Society of Peritoneal Dialysis (PD) for the initial treatment of peritonitis complicating PD are to administer intraperitoneal (IP) cefazolin or cephalothin in every PD fluid bag, together with once-daily gentamicin. In view of the inherent impracticalities of this regimen, we studied the efficacy of once-daily cefazolin (1.5 g) IP with gentamicin IP as initial treatment for primary (nonrecurrent) PD peritonitis. This regimen has been used in all episodes of peritonitis not associated with tunnel or exit-site infections or fluid leaks. Sixty-nine episodes in 61 patients were analyzed (44 patients, continuous ambulatory PD; 22 patients, automated PD; and 3 patients, hospital-based intermittent PD), of which 38 episodes (55%) were gram-positive infections, 6 episodes (9%) were gram-negative infections, and 18 episodes (26%) had negative culture results. Four patients died within 4 weeks of infection (none considered attributable to inadequate treatment of their peritonitis). Ten catheters (14.5%) required removal to clear the infection; 7 catheters were in patients with gram-negative infections. The relapse rate within 4 weeks of ceasing antibiotic therapy was 8.9%. Compared with the results of 40 episodes of peritonitis treated initially with our previous IP vancomycin and gentamicin regimen, successful treatment (no death, catheter removal, or recurrence) was achieved in 52 of 69 episodes in the cefazolin group (75.4%) versus 23 of 40 episodes in the vancomycin group (57.5%; P: = 0.058). In conclusion, once-daily IP cefazolin and gentamicin for the initial treatment of PD peritonitis is at least as effective as a vancomycin-based regimen and is well tolerated.
为减少万古霉素的使用，国际腹膜透析学会（PD）目前对于并发PD的腹膜炎初始治疗的建议是，在每袋腹膜透析液中加入头孢唑林或头孢噻吩进行腹腔内（IP）给药，并联合每日一次的庆大霉素。鉴于该方案存在固有的不切实际之处，我们研究了每日一次腹腔注射头孢唑林（1.5g）联合腹腔注射庆大霉素作为原发性（非复发性）PD腹膜炎初始治疗的疗效。该方案已用于所有与隧道或出口部位感染或液体渗漏无关的腹膜炎发作。分析了61例患者的69次发作（44例持续性非卧床腹膜透析患者；22例自动化腹膜透析患者；3例医院间歇性腹膜透析患者），其中38次发作（55%）为革兰氏阳性菌感染，6次发作（9%）为革兰氏阴性菌感染，18次发作（26%）培养结果为阴性。4例患者在感染后4周内死亡（均不认为是腹膜炎治疗不充分所致）。10根导管（14.5%）因清除感染而需要拔除；7根导管属于革兰氏阴性菌感染的患者。抗生素治疗停止后4周内的复发率为8.9%。与我们之前使用腹腔注射万古霉素和庆大霉素方案初始治疗的40例腹膜炎结果相比，头孢唑林组69次发作中有52次（75.
