Giuliani Anna, Lerco Silvia, Manani Sabrina Milan, Marcello Matteo, Tantillo Ilaria, Nicolin Roberto, Ronco Claudio, Zanella Monica
Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
International Renal Research Institute Vicenza (IRRIV), Italy.
Perit Dial Int. 2023 Mar;43(2):182-185. doi: 10.1177/08968608221132431. Epub 2022 Nov 9.
Peritoneal dialysis (PD) associated peritonitis is the leading cause of PD discontinuation and haemodialysis transfer. Current guidelines strongly recommend prompt initiation of empiric broad-spectrum intraperitoneal antibiotics, with suspected peritonitis. colitis is one of the most common healthcare-associated infections, with increased morbidity and mortality among end-stage kidney disease patients. Clinical presentation is mainly characterised by diarrhoea of varying severity, which may eventually evolve into toxic megacolon and paralytic ileus. However, PD patients with infection (CDI) may also have colitis-triggered peritonitis, presenting challenging scenario for antibiotic treatment strategy, since broad-spectrum antibiotics against peritonitis may worsen CDI-related colitis, while inappropriate or discontinuation of antibiotic therapy may worsen peritonitis. Currently, guidelines on peritonitis management do not include such challenging clinical situations, although increasingly common. We herein describe a case of a patient, with culture-negative PD associated peritonitis and CDI, presenting with diarrhoea, abdominal pain and cloudy effluent.
腹膜透析（PD）相关腹膜炎是导致PD治疗中断和转为血液透析的主要原因。当前指南强烈建议，一旦怀疑发生腹膜炎，应立即开始经验性使用广谱腹腔内抗生素。艰难梭菌感染（CDI）是最常见的医疗相关感染之一，在终末期肾病患者中，其发病率和死亡率均有所增加。临床表现主要为程度各异的腹泻，最终可能发展为中毒性巨结肠和麻痹性肠梗阻。然而，PD合并CDI的患者也可能发生由结肠炎引发的腹膜炎，这给抗生素治疗策略带来了挑战，因为针对腹膜炎使用广谱抗生素可能会使与CDI相关的结肠炎恶化，而不恰当的抗生素治疗或中断治疗则可能使腹膜炎恶化。目前，尽管这种具有挑战性的临床情况日益常见，但腹膜炎管理指南并未涵盖此类情况。我们在此描述一例患者，该患者患有培养阴性的PD相关腹膜炎和CDI，表现为腹泻、腹痛和透析液浑浊。
