葡聚糖阴性凝固酶葡萄球菌相关性腹膜炎：巴西中心 115 例病例回顾。
Peritoneal dialysis-related peritonitis due to coagulase-negative Staphylococcus: a review of 115 cases in a Brazilian center.
机构信息
Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil; and Department of Microbiology and Immunology, Biosciences Institute of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil.
Department of Microbiology and Immunology, Biosciences Institute of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil.
出版信息
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1074-81. doi: 10.2215/CJN.09280913. Epub 2014 Mar 27.
BACKGROUND AND OBJECTIVES
Coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-related peritonitis in many centers. This study aimed to describe clinical and microbiologic characteristics of 115 CNS episodes and to determine factors influencing the outcome.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study reviewed the records of 115 CNS peritonitis episodes that occurred in 74 patients between 1994 and 2011 at a single university center. Peritonitis incidences were calculated for three consecutive 6-year periods (P1, 1994-1999; P2, 2000-2005; P3, 2006-2011) and annually. The production of biofilms, enzymes, and toxins was evaluated. Oxacillin resistance was evaluated based on its minimum inhibitory concentration and the presence of the mecA gene.
RESULTS
The overall incidence of CNS peritonitis was 0.15 episodes per patient per year and did not vary over time (0.12, 0.14, and 0.16 for P1, P2, and P3, respectively; P=0.21). The oxacillin resistance rate was 69.6%. Toxin and enzyme production was infrequent and 36.5% of CNS strains presented the gene encoding biofilm production. The presence of icaAD genes associated with biofilm production was predictive of relapses or repeat episodes (odds ratio [OR], 2.82; 95% confidence interval [95% CI], 1.11 to 7.19; P=0.03). Overall, 70 episodes (60.9%) resolved; oxacillin susceptibility (OR, 4.41; 95% CI, 1.48 to 13.17; P=0.01) and vancomycin use as the first treatment (OR, 22.27; 95% CI, 6.16 to 80.53; P<0.001) were the only independent predictors of resolution.
CONCLUSIONS
Oxacillin resistance and vancomycin use as the first treatment strongly influence the resolution rate in CNS peritonitis, which reinforces the validity of the International Society for Peritoneal Dialysis guidelines on monitoring bacterial resistance to define protocols for initial treatment. These results also suggest that the presence of biofilm is a potential cause of repeat peritonitis episodes.
背景与目的
凝固酶阴性葡萄球菌（CNS）是许多中心腹膜透析（PD）相关腹膜炎的最常见原因。本研究旨在描述 115 例 CNS 感染的临床和微生物学特征，并确定影响预后的因素。
设计、地点、参与者和测量方法：本研究回顾了 1994 年至 2011 年间，74 例患者在单一大学中心发生的 115 例 CNS 腹膜炎发作的记录。计算了三个连续 6 年期间（P1，1994-1999 年；P2，2000-2005 年；P3，2006-2011 年）和每年腹膜炎的发生率。评估了生物膜、酶和毒素的产生。根据最低抑菌浓度和 mecA 基因的存在评估耐苯唑西林情况。
结果
CNS 腹膜炎的总发生率为 0.15 例/患者/年，且无时间变化（P1、P2 和 P3 分别为 0.12、0.14 和 0.16；P=0.21）。耐苯唑西林率为 69.6%。毒素和酶的产生并不常见，36.5%的 CNS 菌株具有生物膜产生的基因。生物膜产生相关的 icaAD 基因的存在与复发或重复发作相关（比值比[OR]，2.82；95%置信区间[95%CI]，1.11 至 7.19；P=0.03）。总体而言，70 例（60.9%）治愈；苯唑西林敏感性（OR，4.41；95%CI，1.48 至 13.17；P=0.01）和万古霉素作为初始治疗（OR，22.27；95%CI，6.16 至 80.53；P<0.001）是治愈的唯一独立预测因素。
结论
耐苯唑西林和万古霉素作为初始治疗强烈影响 CNS 腹膜炎的治愈率，这进一步证实了国际腹膜透析协会监测细菌耐药性以确定初始治疗方案的指南的有效性。这些结果还表明生物膜的存在是腹膜炎复发的潜在原因。
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