Peer G, Serban I, Blum M, Cabili S, Iaina A
Department of Nephrology, Ichilov Hospital, Tel Aviv, Israel.
Am J Nephrol. 1992;12(1-2):19-21. doi: 10.1159/000168412.
The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available. The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria. We performed the LAL assay in a prospective study in 36 consecutive episodes of peritonitis. The LAL assay was positive in all 10 episodes of gram-negative peritonitis (100% specificity). Treatment directed specifically against gram-negative or -positive infection was started based on the LAL assay result. In 26 episodes with LAL-negative test, a gram-positive bacterium was cultured in 23 episodes, in 1 there was fungal infection and 2 were sterile. In summary: the LAL assay is a rapid (1 h) and sensitive method for the differentiation of gram-positive or -negative peritonitis and enables starting an immediate and more appropriate antibiotic therapy.
在获得细菌学结果之前，持续性非卧床腹膜透析患者腹膜炎的治疗是经验性的。鲎试剂检测法是检测内毒素（革兰氏阴性菌的一种结构成分）的一种非常灵敏的方法。我们在一项前瞻性研究中，对36例连续性腹膜炎发作患者进行了鲎试剂检测法。在所有10例革兰氏阴性菌腹膜炎发作中，鲎试剂检测法均呈阳性（特异性100%）。根据鲎试剂检测法的结果，开始针对革兰氏阴性或阳性感染进行特异性治疗。在26例鲎试剂检测呈阴性的发作中，23例培养出革兰氏阳性菌，1例为真菌感染，2例无菌生长。总之：鲎试剂检测法是一种快速（1小时）且灵敏的方法，可用于区分革兰氏阳性或阴性腹膜炎，并能立即开始更合适的抗生素治疗。
