Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.
Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Lombardia, Italy.
J Vasc Access. 2024 Jul;25(4):1341-1344. doi: 10.1177/11297298231178061. Epub 2023 May 30.
Pseudomonas peritonitis is often severe and associated with less than 50% complete cure rate, often requiring catheter removal, and transfer to HD. International guidelines recommend that peritoneal catheter should be removed if peritoneal dialysis (PD) effluent does not clear after 5 days of appropriate antibiotic therapy defining the episode as refractory peritonitis. To avoid the shift to hemodialysis (HD), the simultaneous removal and replacement of the peritoneal catheter (SCR) has been employed to treat recurrent peritonitis or tunnel infections associated with peritonitis, obtaining satisfactory outcomes. However, the use of SCR is still controversial in refractory episodes. At present there is growing evidence that refractory peritonitis can be sustained by bacterial adherence along the intraperitoneal portion of the catheter, especially when Pseudomonas species are involved. We describe a case of refractory peritonitis sustained by P. aeruginosa that after a partial response to antibiotics has been successfully treated by SCR.
铜绿假单胞菌性腹膜炎通常较为严重，治愈率不足 50%，常需要拔除导管并转至血液透析。国际指南建议，如果在适当的抗生素治疗 5 天后腹膜透析（PD）流出物仍未清除，则将腹膜导管定义为难治性腹膜炎，应将其移除。为避免转为血液透析（HD），已采用同时移除和更换腹膜导管（SCR）来治疗与腹膜炎相关的复发性腹膜炎或隧道感染，取得了满意的结果。然而，在难治性发作时，SCR 的使用仍存在争议。目前有越来越多的证据表明，难治性腹膜炎可由细菌沿导管的腹腔内部分附着引起，尤其是当涉及铜绿假单胞菌时。我们描述了一例由铜绿假单胞菌引起的难治性腹膜炎，在抗生素治疗后出现部分缓解，随后成功地通过 SCR 进行了治疗。
