Scalamogna A, Castelnovo C, De Vecchi A, Ponticelli C
Divisione di Nefrologia e Dialisi, Ospedale Maggiore di Milano, Italy.
Am J Kidney Dis. 1991 Dec;18(6):674-7. doi: 10.1016/s0272-6386(12)80608-1.
One hundred two exit-site infections (ESI) were diagnosed in 63 of 163 (38.6%) patients, with an incidence of one episode every 23.7 patient-months in patients with a history of ESI, whereas in the overall continuous ambulatory peritoneal dialysis (CAPD) population the incidence was one episode every 48.7 patient-months. In diminishing order of frequency, the bacteria isolated were Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli. The probability of remaining free of ESI was 72% at 1 year and 45% at 5 years. The ESI that led to catheter removal were due to S aureus and gram-negative rods. In 13 (48%) of 27 S aureus ESI unresponsive to antibiotics and local care, deroofing and outer cuff shaving completely resolved the ESI. Despite this treatment, the catheters of the remaining 14 patients had to be removed because of peritonitis associated with the tunnel infection. In conclusion, ESI is a major cause of CAPD failure. In our series, shaving the cuff as a rescue treatment was effective for almost 50% of the patients with antibiotic-resistant S aureus ESI.
163例患者中有63例（38.6%）诊断出102次出口部位感染（ESI），有ESI病史的患者每23.7患者月发生1次感染，而在整个持续性非卧床腹膜透析（CAPD）人群中，发生率为每48.7患者月1次。按分离出细菌的频率递减顺序依次为金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌和大肠杆菌。1年时无ESI的概率为72%，5年时为45%。导致导管拔除的ESI是由金黄色葡萄球菌和革兰氏阴性杆菌引起的。在27例对抗生素和局部护理无反应的金黄色葡萄球菌ESI中，有13例（48%）通过去除覆盖物和刮除外部袖套使ESI完全消退。尽管进行了这种治疗，但其余14例患者的导管因与隧道感染相关的腹膜炎而不得不拔除。总之，ESI是CAPD失败的主要原因。在我们的系列研究中，刮除袖套作为挽救治疗对近50%的耐抗生素金黄色葡萄球菌ESI患者有效。
