Kopriva-Altfahrt Gertrude, König Paul, Mündle Michael, Prischl Friedrich, Roob Johannes M, Wiesholzer Martin, Vychytil Andreas, Arneitz Kalus, Karner Andrea, Artes Rene, Wolf Erich, Auinger Martin, Pawlak Andrzej, Fraberger Johannes, Hofbauer Sabine, Galvan Georg, Salmhofer Hermann, Pichler Birgit, Wazel Melanie, Gruber Manfred, Thonhofer Anni, Hager Alfred, Malajner Sabine, Heiss Susanne, Braunsteiner Thomas, Zweiffler Monika, König Paul, Rudnicki Michael, Kogler Richard, Kohlhauser Dietmar, Wiesinger Tatjana, Kopriva-Altfahrt Gertrude, Moser Elizabeth, Kotanko Peter, Loibner Herbert, Nitz Helga, Miska Hans Joachim, Wenzel René, Wölfer Monika, Mündle Michael, Breuss Heimo, Hölzl Bertram, Prischi Friedrich, Schmekal Bernhard, Riener Eva-Maria, Roob Johannes M, Wonisch Waltraud, Vikydal Rudolf, Vychytil Andreas, Frank Barbara, Wieser Clemens, Wiesholzer Martin, Pokorny Karin
Division of Nephrology and Dialysis, Department of Medicine VI, Wilhelminenspital, Vienna.
Perit Dial Int. 2009 May-Jun;29(3):330-9.
Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections.
In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria.
Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine (n = 155), sodium hypochlorite (n = 31), povidone iodine + sodium hypochlorite together (n = 102), and octenidine dihydrochloride/phenoxyethanol (n = 17). Water + non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol.
Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers (e.g., by establishing a prophylaxis protocol).
导管相关感染显著导致腹膜透析（PD）患者治疗失败。围绕预防这些感染的预防策略存在诸多争议。
在这项全国性多中心研究中，我们分析了2006年奥地利PD中心实施的预防导管相关感染的策略。向奥地利所有23个PD中心发送了一份调查问卷。
奥地利23个PD中心治疗的332例患者使用了10种不同的导管型号。23个PD中心中有17个在置管前给予全身抗生素（糖肽类，n = 7；头孢菌素类，n = 10）。17个PD中心术前进行鼻拭子检查；其中15个中心对鼻腔金黄色葡萄球菌携带者用莫匹罗星乳膏进行预防性治疗。332例慢性PD患者中有318例常规更换敷料（非封闭性薄膜敷料，n = 58；纱布敷料，n = 260）。慢性出口部位护理用的消毒剂包括聚维酮碘（n = 155）、次氯酸钠（n = 31）、聚维酮碘 + 次氯酸钠联合使用（n = 102）以及二盐酸奥替尼啶/苯氧乙醇（n = 17）。27例患者使用水 + 非消毒肥皂或0.9%氯化钠作为出口部位的清洁制剂。12个PD中心对慢性PD患者进行常规金黄色葡萄球菌筛查（鼻腔和/或出口部位拭子）；其中11个中心对携带者用莫匹罗星乳膏进行治疗。8个PD中心对透析工作人员进行金黄色葡萄球菌筛查，5个PD中心对患者配偶进行金黄色葡萄球菌筛查。总体出口部位感染率为1次/43.9患者 - 月，隧道感染率为1次/88.9患者 - 月，腹膜炎发生率为1次/51.0患者 - 月。与未使用预防方案的中心相比，已制定治疗金黄色葡萄球菌携带者预防方案的中心患者平均感染率较低。
奥地利PD中心采用了各种个体化预防策略来预防导管相关感染。感染率在文献报道范围内。一些中心仍有改进空间（例如，通过制定预防方案）。
