Seriburi Vimon, Reynolds Jeffrey
Hospital of Saint Raphael, New Haven, USA.
Conn Med. 2007 May;71(5):281-3.
Peritonitis is a common complication in peritoneal dialysis (PD). Epidemiology of the causative organism varied over time, but anaerobes are still extremely rare. We describe a second reported case of Clostridium perfringens peritonitis in a peritoneal dialysis patient since 1998. The patient presented with PD-related peritonitis that did not respond to the antibiotic choice recommended by the International Society of Peritoneal Dialysis guidelines. We used piperacillin/tazobactam with good result, when the dialysate culture revealed a gram-positive anaerobe. We postulate that Clostridium perfringen came from an enteric source by translocation. A few studies have implicated diverticular disease and gastric acid inhibitors in PD-related enteric peritonitis, and the results are still controversial. Further study is needed to establish a correlation between bowel pathology and enteric peritonitis in peritoneal dialysis patients.
腹膜炎是腹膜透析（PD）的常见并发症。致病菌的流行病学情况随时间变化，厌氧菌仍然极为罕见。我们描述了自1998年以来腹膜透析患者中第二例产气荚膜梭菌腹膜炎的报告病例。该患者出现与腹膜透析相关的腹膜炎，对国际腹膜透析学会指南推荐的抗生素选择无反应。当透析液培养显示为革兰氏阳性厌氧菌时，我们使用哌拉西林/他唑巴坦取得了良好效果。我们推测产气荚膜梭菌通过移位来自肠道来源。一些研究表明憩室病和胃酸抑制剂与腹膜透析相关的肠道腹膜炎有关，结果仍存在争议。需要进一步研究以确定腹膜透析患者肠道病理与肠道腹膜炎之间的相关性。
