Yi Chunyan, Zhang Wenbo, Guo Qunying, Lin Jianxiong, Chen Wei, Mao Haiping, Yang Xiao
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
National Health Commission Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
Kidney Dis (Basel). 2024 May 30;10(4):295-302. doi: 10.1159/000539582. eCollection 2024 Aug.
Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis.
Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared.
One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7-79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; < 0.001). Non-compliance with management algorithm (OR = 185.861, < 0.001) together with advance age (OR = 1.116, < 0.001) and longer distance from home to hospital (OR = 1.007, < 0.001) were independent risk factors for wet contamination-associated peritonitis.
The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.
湿污染是腹膜透析（PD）系统的常见问题。我们基于相关研究文献和临床实践经验，制定了一种针对PD系统湿污染的管理算法。本研究旨在观察该管理算法在预防腹膜炎方面的临床效果。
纳入2017年10月至2022年9月在单一PD中心接受湿污染治疗的患者。建立了一种治疗湿污染的管理算法。它包括污染类型的识别、处理受污染或老化的导管、预防性使用抗生素以及再培训。收集并比较了有关湿污染的人口统计学数据和临床数据。
本研究共纳入141例湿污染病例。平均年龄为51.7±14.1岁，女性占49.6%。糖尿病肾病的比例为9.9%。腹膜透析的中位时间为27.0（1.7 - 79.7）个月。18例（12.8%）湿污染相关腹膜炎在湿污染后发生。腹膜炎的主要病原菌为革兰氏阳性菌（33.3%）和革兰氏阴性菌（27.8%）。遵循管理算法组的湿污染相关腹膜炎发生率显著低于未遵循管理算法组（0.9%对48.6%；P<0.001）。不遵循管理算法（OR = 185.861，P<0.001）、高龄（OR = 1.116，P<0.001）以及住家到医院距离较远（OR = 1.007，P<0.001）是湿污染相关腹膜炎的独立危险因素。
PD系统湿污染的管理算法可降低腹膜炎风险。
