Department of Internal Medicine-Infectious Disease Unit, University Hospital of Heraklion, 71 110, Heraklion, Crete, Greece.
Int J Infect Dis. 2010 Jun;14(6):e489-93. doi: 10.1016/j.ijid.2009.07.016. Epub 2009 Nov 18.
The objective of this study was to identify the epidemiological, clinical, and microbiological factors affecting the outcome of peritoneal dialysis (PD)-associated peritonitis.
All patients with PD-associated peritonitis, cared for at the University Hospital of Heraklion from 1990 to 2007, were retrospectively studied.
A total of 247 episodes of PD-associated peritonitis occurring in 82 patients were evaluated. The median age of patients was 68 years (range 10-92 years); 51 (62%) were males. There were 104 episodes (42%) of Gram-positive peritonitis, 46 (19%) of Gram-negative peritonitis, 13 (5%) of polymicrobial peritonitis, and 11 (4%) of fungal peritonitis. There were 64 (26%) complicated episodes. The latter included 22 (8.9%) relapses, 13 (5.3%) repeated episodes, 18 (7.3%) catheter removals, and 11 (4.5%) deaths. In multivariate analysis, the presence of a purulent exit-site infection (p<0.001), peritoneal dialysis effluent cell count >100 x 10(6)/l for more than 5 days (p<0.001), use of antimicrobials during the preceding 3 months (p<0.05), and low serum total protein level on admission (p<0.05) were independent predictors of a complicated course.
Exit-site infection, more than 5 days with a peritoneal dialysis effluent cell count >100 x 10(6)/l, prior use of antimicrobials, and low serum total protein level are potential predictors of complicated PD-associated peritonitis and may distinguish high-risk cases.
本研究旨在确定影响腹膜透析（PD）相关性腹膜炎结局的流行病学、临床和微生物学因素。
回顾性分析 1990 年至 2007 年期间在克里特大学医院接受治疗的所有 PD 相关性腹膜炎患者。
共评估了 82 例患者的 247 次 PD 相关性腹膜炎发作。患者的中位年龄为 68 岁（范围 10-92 岁）；51 例（62%）为男性。104 例（42%）为革兰阳性腹膜炎，46 例（19%）为革兰阴性腹膜炎，13 例（5%）为混合微生物腹膜炎，11 例（4%）为真菌性腹膜炎。有 64 例（26%）为复杂病例。其中包括 22 例（8.9%）复发、13 例（5.3%）反复发作、18 例（7.3%）导管拔除和 11 例（4.5%）死亡。多变量分析显示，存在脓性出口部位感染（p<0.001）、腹膜透析流出液细胞计数>100 x 10(6)/l 超过 5 天（p<0.001）、在之前 3 个月内使用抗生素（p<0.05）以及入院时血清总蛋白水平较低（p<0.05）是复杂病程的独立预测因素。
出口部位感染、腹膜透析流出液细胞计数>100 x 10(6)/l 超过 5 天、之前使用抗生素以及血清总蛋白水平较低是 PD 相关性腹膜炎复杂的潜在预测因素，可能区分高危病例。
