Kavanagh David, Prescott Gordon J, Mactier Robert A
The Scottish Renal Registry, Royal Infirmary, Castle Street, Glasgow G4 0SF, UK.
Nephrol Dial Transplant. 2004 Oct;19(10):2584-91. doi: 10.1093/ndt/gfh386. Epub 2004 Aug 10.
Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD).
All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months.
Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases.
PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.
腹膜炎是腹膜透析（PD）的主要并发症。我们对苏格兰所有接受腹膜透析治疗的患者进行了一项为期3.5年的全国性研究，调查技术失败的原因、腹膜炎发生率、致病菌、临床结局以及自动化腹膜透析（APD）和持续性非卧床腹膜透析（CAPD）之间的差异。
苏格兰所有10个成人肾脏科室都参与了该研究，数据包括1999年1月至2002年6月期间在苏格兰接受腹膜透析治疗的所有1205例患者。数据由腹膜透析护士前瞻性收集，并每6个月向苏格兰肾脏登记处报告一次。
难治性或复发性腹膜炎是167例患者技术失败的原因（占所有技术失败病例的42.6%）。在1487患者年中有928例腹膜炎病例，相当于总体腹膜炎发生率为每19.2个月发生一次。APD和CAPD的腹膜炎发生率相似，分别为每20.3个月发生一次和每18.6个月发生一次。这些结果包括88例因复发或再感染导致的腹膜炎病例。使用鼻用莫匹罗星的科室与未使用的科室之间的腹膜炎发生率存在统计学显著差异（P = 0.012）（分别为每21.9个月发生一次和每18.3个月发生一次）。凝固酶阴性葡萄球菌是腹膜炎最常见的病因（29%），尽管这一比例低于以往研究。总体初始治愈率为75%。APD的初始治愈率为77.2%，CAPD的初始治愈率为73.7%。17%的病例未分离出致病菌。
在苏格兰，与腹膜透析相关的腹膜炎是技术失败的主要原因。我们证实了先前的研究结果，即凝固酶阴性葡萄球菌引起的腹膜炎发作比例有所下降。在苏格兰，APD的腹膜炎发生率并不显著优于CAPD，且APD和CAPD的初始治愈率相似。
