Lui Sing Leung, Yip Terence, Tse Kai Chung, Lam Man Fai, Lai Kar Neng, Lo Wai Kei
Division of Nephrology, University Department of Medicine, Tung Wah Hospital, 12, PoYan Street, Sheung Wan, Hong Kong SAR, People's Republic of China.
Perit Dial Int. 2005 Nov-Dec;25(6):560-3.
Patients on continuous ambulatory peritoneal dialysis (CAPD) with Pseudomonas aeruginosa exit-site infection (ESI) refractory to antibiotic treatment often require replacement of their peritoneal dialysis catheter (PDC). The optimal interval between removal and reinsertion of the PDC is not known. There are relatively few data on the feasibility of simultaneous removal and reinsertion of dialysis catheters for the treatment of P. aeruginosa ESI.
We retrospectively reviewed the short- and long-term outcomes of all CAPD patients who had undergone simultaneous removal and reinsertion of their PDC for the treatment of refractory P. aeruginosa ESI in our hospital between January 1994 and December 2003. During the operation, the old catheter was removed first and a new catheter was inserted into the opposite side of the abdomen. All patients received 7 days of antibiotic therapy postoperatively. CAPD was resumed after 2 weeks of intermittent peritoneal dialysis.
Over a 10-year period, 37 CAPD patients underwent the operation. Mean age of the patients was 59.5 +/- 10.9 years. The interval between the diagnosis of ESI and the operation was 16.7 +/- 6.9 weeks. The patients received 7.6 +/- 2.5 weeks of antibiotic treatment before the procedure. Early postoperative complications were uncommon. None of the patients developed ESI within 4 weeks after the operation. At 1 year after the operation, 3 patients (8%) had developed recurrence of P. aeruginosa ESI 24 - 40 weeks postoperatively. Peritonitis due to P. aeruginosa was not observed.
We conclude that simultaneous removal and reinsertion of the PDC is feasible in eradicating refractory ESI due to P. aeruginosa. This procedure alleviates the need for temporary hemodialysis and allows continuation of peritoneal dialysis.
持续性非卧床腹膜透析（CAPD）患者若发生铜绿假单胞菌出口处感染（ESI）且抗生素治疗无效，通常需要更换腹膜透析导管（PDC）。PDC拔除与重新插入的最佳间隔时间尚不清楚。关于同时拔除和重新插入透析导管治疗铜绿假单胞菌ESI的可行性的数据相对较少。
我们回顾性分析了1994年1月至2003年12月期间在我院因难治性铜绿假单胞菌ESI而同时拔除和重新插入PDC的所有CAPD患者的短期和长期结局。手术过程中，先拔除旧导管，然后在腹部对侧插入新导管。所有患者术后接受7天抗生素治疗。间歇性腹膜透析2周后恢复CAPD。
在10年期间，37例CAPD患者接受了该手术。患者的平均年龄为59.5±10.9岁。ESI诊断至手术的间隔时间为16.7±6.9周。术前患者接受了7.6±2.5周的抗生素治疗。术后早期并发症并不常见。术后4周内无患者发生ESI。术后1年，3例患者（8%）在术后24 - 40周出现铜绿假单胞菌ESI复发。未观察到铜绿假单胞菌引起的腹膜炎。
我们得出结论，同时拔除和重新插入PDC对于根除难治性铜绿假单胞菌ESI是可行的。该手术减少了临时血液透析的需求，并允许继续进行腹膜透析。
