牛链球菌性腹膜炎合并腹膜透析——10 年经验回顾。
Streptococcus bovis peritonitis complicating peritoneal dialysis--a review of 10 years' experience.
机构信息
Division of Nephrology, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, PR China.
出版信息
Perit Dial Int. 2012 Jan-Feb;32(1):55-9. doi: 10.3747/pdi.2010.00304. Epub 2011 Jul 31.
OBJECTIVE
An association of Streptococcus bovis bacteremia with carcinoma of colon has been reported, but data regarding peritoneal dialysis (PD) peritonitis caused by S. bovis is scarce. In this study, we examined the clinical characteristics, associations, and outcomes of this disease entity.
METHODS
The case records of patients with S. bovis PD peritonitis presenting to 2 renal centers between January 2000 and September 2010 were reviewed. Clinical features and outcomes were identified and analyzed.
RESULTS
Of cultures from 23 episodes of S. bovis peritonitis in 20 patients (1.28% of all peritonitis episodes at our center), 19 (82.6%) showed S. bovis alone, and 4 (17.4%) showed mixed growth. In 7 episodes, the S. bovis was moderately resistant to penicillin G. Rates of resistance to clindamycin and erythromycin were 43.5% and 47.8% respectively. In 18 episodes (78.3%), a primary response was achieved with a first-generation cephalosporin and an aminoglycoside. In 4 episodes, a secondary response was achieved after a switch from cephalosporin to vancomycin, and in 1 episode with mixed growth, the Tenckhoff catheter had to be removed. Repeat peritonitis occurred in 3 patients at a mean of 50.0 months (range: 24.2 - 83.1 months). Of the 20 patients of S. bovis peritonitis, 10 (50%) underwent either a barium enema or a colonoscopy. One patient had history of colonic carcinoma 2 years before the peritonitis, and a subsequent work-up revealed no recurrence. Three patients had diverticulosis, and one had a concomitant sigmoid polyp. Findings in the other 6 patients were normal. No colorectal malignancy had developed in the remaining 10 patients after a mean follow-up of 76.6 months (range: 0.8 - 125.1 months).
CONCLUSIONS
Outcomes in S. bovis PD peritonitis were favorable, and an association with colorectal cancer was not found in our patients. Routine colonoscopy in these patients remains controversial and should be individualized.
目的
已有研究表明，牛链球菌菌血症与结肠癌之间存在关联，但有关牛链球菌引起的腹膜透析（PD）相关性腹膜炎的数据却很少。本研究旨在探讨该疾病实体的临床特征、相关性和结局。
方法
回顾 2000 年 1 月至 2010 年 9 月期间 2 家肾脏中心收治的 20 例患者 23 例牛链球菌 PD 相关性腹膜炎的病例记录。对临床特征和结局进行了识别和分析。
结果
在我们中心所有腹膜炎病例中，20 例患者的 23 例（1.28%）牛链球菌培养阳性，19 例（82.6%）单纯为牛链球菌感染，4 例（17.4%）为混合感染。在 7 例中，牛链球菌对青霉素 G 中度耐药，对克林霉素和红霉素的耐药率分别为 43.5%和 47.8%。在 18 例（78.3%）中，第一代头孢菌素和氨基糖苷类药物首次治疗即可获得原发缓解。在 4 例中，将头孢菌素更换为万古霉素后获得继发缓解，在 1 例混合感染中，需要将 Tenckhoff 导管取出。3 例患者在平均 50.0 个月（范围：24.2-83.1 个月）时复发腹膜炎。在 20 例牛链球菌腹膜炎患者中，10 例（50%）接受了钡灌肠或结肠镜检查。1 例患者在腹膜炎前 2 年有结肠癌病史，进一步检查未发现复发。3 例患者有憩室病，1 例有乙状结肠息肉。其余 6 例患者的检查结果正常。在平均随访 76.6 个月（范围：0.8-125.1 个月）后，其余 10 例患者未发生结直肠恶性肿瘤。
结论
牛链球菌 PD 相关性腹膜炎的结局良好，我们的患者中未发现与结直肠癌有关。在这些患者中常规行结肠镜检查仍存在争议，应个体化考虑。
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