Peterson P K, Matzke G, Keane W F
Rev Infect Dis. 1987 May-Jun;9(3):604-12. doi: 10.1093/clinids/9.3.604.
During the past five years, continuous ambulatory peritoneal dialysis (CAPD) has become recognized as a major form of therapy for end-stage renal disease. Despite continued advances, peritonitis remains a major limiting factor in the widespread application of CAPD. The pathogenesis of CAPD peritonitis is strikingly different from that of surgical peritonitis. Not only are the sources of infection and the microbiologic findings dissimilar, but the severity of infection is markedly different. Moreover, in CAPD peritonitis, both biofilms (extracellular slime substances) associated with microbial growth on the implanted silicone catheter and compromised local defenses (depletion of opsonins and intracellular survival of certain microorganisms) are of pathogenic importance. Once the diagnosis of peritonitis is suspected, therapy should be instituted immediately. However, the optimal antibiotic regimen and the best route, dose, and duration of antibiotic administration remain unknown because of a paucity of randomized, controlled studies. New approaches to the prevention and treatment of CAPD peritonitis are being evaluated; if this infection can be successfully managed, CAPD promises to become increasingly popular for the treatment of chronic renal failure.
在过去五年中，持续性非卧床腹膜透析（CAPD）已成为终末期肾病的一种主要治疗方式。尽管不断取得进展，但腹膜炎仍然是CAPD广泛应用的一个主要限制因素。CAPD相关性腹膜炎的发病机制与外科性腹膜炎显著不同。不仅感染源和微生物学表现不同，而且感染的严重程度也明显不同。此外，在CAPD相关性腹膜炎中，与植入的硅胶导管上微生物生长相关的生物膜（细胞外黏液物质）和局部防御功能受损（调理素耗竭和某些微生物在细胞内存活）都具有致病重要性。一旦怀疑腹膜炎诊断，应立即开始治疗。然而，由于缺乏随机对照研究，最佳抗生素方案以及抗生素给药的最佳途径、剂量和疗程仍不清楚。预防和治疗CAPD相关性腹膜炎的新方法正在评估中；如果这种感染能够得到成功控制，CAPD有望在慢性肾衰竭的治疗中越来越受欢迎。
