Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea.
Nephrology (Carlton). 2012 Nov;17(8):760-6. doi: 10.1111/j.1440-1797.2012.01644.x.
Catheter-related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal.
We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed.
The total PD duration of all patients was 32,581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient-months (0.12/patient-year). The most common causative organism was methicillin-sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin-resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S.aureus (6/21, 28.6%).
Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.
导管相关性感染是腹膜透析（PD）中导管丢失的主要原因。我们评估了在需要拔除导管的 PD 患者中，对难治性出口部位感染（ESI）/隧道感染（TI）进行导管翻修的治疗效果。
我们回顾了我院 1995 年 5 月至 2011 年 4 月间 764 例持续非卧床腹膜透析（CAPD）患者的病历资料。126 例患者 ESI 反复发作。对难治性 ESI/TI 采用导管翻修治疗。分析 ESI 的发生率、病原菌和导管翻修的结果。
所有患者的 PD 总时长为 32581 个月。126 例患者共发生 312 次 ESI，发生率为 1/104 患者-月（0.12/患者-年）。最常见的病原菌为甲氧西林敏感金黄色葡萄球菌（MSSA）（98 例），其次为铜绿假单胞菌（63 例）和耐甲氧西林金黄色葡萄球菌（MRSA）（28 例）。其中 36 例因难治性 ESI/TI 需要进行导管翻修。导管翻修病例中最常见的病原菌是 MSSA（14 例），其次是铜绿假单胞菌（10 例）和 MRSA（6 例）。导管翻修的结果如下：11 例（30.6%）患者在导管翻修后 ESI 复发。其中 5 例经抗生素治疗，2 例需要再次导管翻修，4 例因 ESI/TI 合并腹膜炎而拔除导管。导管翻修后 1 年的导管存活率为 89.7%。铜绿假单胞菌引起的 ESI（5/10，50%）和金黄色葡萄球菌引起的 ESI（6/21，28.6%）在导管翻修后 ESI 复发率方面无统计学差异。
在考虑 PD 患者拔除导管之前，导管翻修可能是治疗难治性 ESI/TI 的一种替代治疗选择。
Zotero 插件