Hsueh Leon, Hu Susie L, Shah Ankur D
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
Kidney Dis (Basel). 2021 Mar;7(2):90-99. doi: 10.1159/000513773. Epub 2021 Feb 18.
Peritonitis is a leading complication of peritoneal dialysis (PD). One strategy that the International Society for Peritoneal Dialysis (ISPD) has used to help mitigate the morbidity and mortality associated with peritonitis is through prevention, including antibiotic prophylaxis utilization in high-risk situations. The aim of this study is to summarize our current understanding of postprocedural peritonitis and discuss the existing data behind periprocedural antibiotic prophylaxis, focusing primarily on PD catheter insertion, dental procedures, colonoscopies, upper endoscopies with gastrostomy, and gynecologic procedures.
The ISPD currently recommends intravenous antibiotics prior to PD catheter insertion, colonoscopies, and invasive gynecologic procedures, though prophylaxis has only demonstrated benefit in a prospective, randomized control setting for PD catheter insertion. However, multiple retrospective studies exist that support the use of antibiotic prophylaxis for the other 2 procedures. No specific antibiotic regimen has been established as most optimal to prevent peritonitis for any of the 3 procedures. Antibiotic coverage should include the Enterobacteriaceae family, as well as Gram-positive organisms commonly found on the skin flora for PD catheter insertion, anaerobes for colonoscopies, and common organisms from the urogenital flora in gynecologic procedures. Additionally, the ISPD currently recommends oral amoxicillin prior to dental procedures. There is currently no ISPD recommendation to provide antibiotic prophylaxis prior to an upper endoscopy with or without gastrostomy, though this is a potential area for research.
PD patients are at high risk for developing peritonitis after typical procedures. Antibiotic prophylaxis is a potential strategy that the ISPD utilizes to prevent these infections. However, further research needs to be done to determine the optimal antibiotic regimen.
腹膜炎是腹膜透析（PD）的主要并发症。国际腹膜透析学会（ISPD）用来帮助减轻与腹膜炎相关的发病率和死亡率的一种策略是预防，包括在高风险情况下使用抗生素预防。本研究的目的是总结我们目前对术后腹膜炎的认识，并讨论围手术期抗生素预防背后的现有数据，主要关注PD导管插入、牙科手术、结肠镜检查、带胃造口术的上消化道内镜检查和妇科手术。
ISPD目前建议在PD导管插入、结肠镜检查和侵入性妇科手术前使用静脉抗生素，尽管预防仅在PD导管插入的前瞻性随机对照研究中显示出益处。然而，有多项回顾性研究支持在其他两种手术中使用抗生素预防。尚未确定任何一种手术预防腹膜炎的最优化抗生素方案。抗生素覆盖范围应包括肠杆菌科，以及PD导管插入时皮肤菌群中常见的革兰氏阳性菌、结肠镜检查时的厌氧菌和妇科手术中泌尿生殖系统菌群中的常见菌。此外，ISPD目前建议在牙科手术前口服阿莫西林。目前ISPD没有建议在有或没有胃造口术的上消化道内镜检查前进行抗生素预防，不过这是一个潜在的研究领域。
PD患者在典型手术后发生腹膜炎的风险很高。抗生素预防是ISPD用于预防这些感染的一种潜在策略。然而，需要进一步研究以确定最佳抗生素方案。
