Pattanachaiwit Noppanit, Gojaseni Pongsathorn, Junrak Jukrit, Riengchan Pattaya, Pajareya Thaweepong, Chittinandana Anutra
Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2011 Sep;94 Suppl 4:S44-51.
The percentage of utilizing peritoneal dialysis (PD) in Thailand was increased dramatically since the implementation of PD-First policy in 2008. However, peritonitis remains a major obstacle to achieve success of this modality. The aim of the present study, was to assess the clinical characteristics of PD peritonitis in the PD-first policy era.
The PD peritonitis patients in Bhumibol Adulyadej Hospital between October 2008 and December 2010 were reviewed. Microbiological diagnosis, treatment responses, technique, and patient survival were analyzed.
Since October 2008, 93 peritoneal dialysis patients were followed-up in Bhumibol Adulyadej Hospital including 75 new cases. During the present study period of 1,560 patient-months, 51 episodes of peritonitis from 33 cases were recorded and analyzed. The mean age of the peritonitis patients was 57.9 +/- 16.1 years and 63.6% were females. The most common isolates were gram negative organisms (33.3%) followed by gram positive (17.6%) and fungi (5.9%). Nocardiosis was diagnosed in 1 patient. However, 43.1% of episodes were culture-negative peritonitis. Treatment of peritonitis resulted in a complete cure in 74.5% of patients while 7.8% of patients required catheter removal, and 17.6% died. Event-free survival was better in gram positive organisms (43.3 months) compared with those infected with gram negative (26.8 months) and culture negative peritonitis (16.1 months).
The proportions of peritonitis due to gram negative organisms were increased and associated with less favorable outcome. These findings suggest that it is necessary to prepare the appropriate protocol for prevention and treatment of PD peritonitis under national PD-First policy scheme.
自2008年实施“腹膜透析优先”政策以来，泰国腹膜透析（PD）的使用率大幅提高。然而，腹膜炎仍然是该治疗方式取得成功的主要障碍。本研究的目的是评估“腹膜透析优先”政策时代PD腹膜炎的临床特征。
回顾性分析了2008年10月至2010年12月期间在诗丽吉王后医院接受治疗的PD腹膜炎患者。分析了微生物学诊断、治疗反应、技术和患者生存率。
自2008年10月以来，诗丽吉王后医院对93例腹膜透析患者进行了随访，其中包括75例新病例。在本研究的1560个患者月期间，记录并分析了33例患者发生的51次腹膜炎发作。腹膜炎患者的平均年龄为57.9±16.1岁，女性占63.6%。最常见的分离菌是革兰氏阴性菌（33.3%），其次是革兰氏阳性菌（17.6%）和真菌（5.9%）。1例患者被诊断为诺卡菌病。然而，43.1%的发作是培养阴性腹膜炎。腹膜炎治疗使74.5%的患者完全治愈，7.8%的患者需要拔除导管，17.6%的患者死亡。革兰氏阳性菌感染患者的无事件生存率（43.3个月）优于革兰氏阴性菌感染患者（26.8个月）和培养阴性腹膜炎患者（16.1个月）。
革兰氏阴性菌引起的腹膜炎比例增加，且预后较差。这些发现表明，有必要在国家“腹膜透析优先”政策框架下制定预防和治疗PD腹膜炎的适当方案。
