Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, The University Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China.
Perit Dial Int. 2011 Sep-Oct;31(5):522-8. doi: 10.3747/pdi.2009.00260. Epub 2011 Apr 30.
Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear.
We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009.
During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005).
Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.
肠球菌是胃肠道正常菌群的一部分。它们可引起肠源性腹膜炎，这是腹膜透析（PD）的严重并发症。然而，PD 相关肠球菌性腹膜炎的临床病程和结局仍不清楚。
我们回顾了 1995 年至 2009 年期间在我们透析单位发生的所有肠球菌性腹膜炎发作。
在研究期间，共记录了 1421 例腹膜炎发作。在 29 例（2.0%）归因于单一病原体肠球菌的发作中，12 例由粪肠球菌引起，9 例由屎肠球菌引起，其余 8 例由其他肠球菌引起。氨苄西林耐药率总体为 41.4%。近期使用抗生素与氨苄西林耐药肠球菌（ARE）性腹膜炎的发生相关（风险比：12.53；p = 0.04）。肠球菌性腹膜炎的初始治疗反应率明显高于大肠埃希菌性腹膜炎（89.7%比 69.9%，p = 0.038），但 ARE 性腹膜炎的初始治疗反应率并不明显低于氨苄西林敏感肠球菌（ASE）性腹膜炎（83.3%比 94.1%，p = 0.553）。然而，更多的 ARE 患者接受了万古霉素治疗（83.3%比 23.5%，p = 0.003），万古霉素治疗的平均持续时间更长（11.8 ± 6.9 天比 3.7 ± 6.8 天，p = 0.005）。
近期使用抗生素是 ARE 性腹膜炎发生的危险因素。ASE 和 ARE 性腹膜炎的结局相似，但 ARE 性腹膜炎的治疗需要使用万古霉素，这可能使患者更容易感染耐万古霉素的病原体。
