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腹膜透析患者因前腹壁体位改变导致的隧道感染和腹膜炎:病例报告

Tunnel Infection and Peritonitis Induced by Due to Decubitus Change of the Anterior Abdominal Wall in a Patient on Peritoneal Dialysis: Case Report.

作者信息

Baralić Marko, Bontić Ana, Pavlović Jelena, Karadžić-Ristanović Vidna, Gajić Selena, Jevtić Jovan, Popović Pavle, Petrović Kristina, Hadži-Tanović Lara, Kezić Aleksandra

机构信息

Clinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.

Faculty of Medicine, University of Belgrade, Dr Subotića Starijeg 8, 11000 Belgrade, Serbia.

出版信息

Microorganisms. 2024 Dec 17;12(12):2608. doi: 10.3390/microorganisms12122608.

Abstract

The occurrence of anterior abdominal wall ulcer at the site of the peritoneal catheter (PC) is one of the rarest complications of peritoneal dialysis (PD). When present, it is mainly caused by which respond well to vancomycin therapy. Despite well-conducted therapy, there is a tendency to relapse and induce peritonitis, which makes it necessary to remove the PC and change the dialysis model of treatment and/or re-insert the catheter at another place to preserve PD as a treatment method. In the present study, we discuss a case of a 53-year-old patient with end-stage kidney disease treated with PD and with decubitus changes at the PC exit site; the change occurred due to migration of the catheter middle part by protruding from the abdominal cavity to the skin, thus allowing ulcer appearance. Although the PC site was treated with antibiotics, as advised by the surgeon, the patient was finally transferred to hemodialysis as the repositioning of the catheter was not performed. This leads to the conclusion that the antibiotic treatment and catheter repositioning are mandatory to preserve peritoneal dialysis as an end-stage kidney disease (ESKD) treatment model.

摘要

腹膜导管(PC)部位的腹壁前部溃疡是腹膜透析(PD)最罕见的并发症之一。一旦出现,主要由对万古霉素治疗反应良好的因素引起。尽管进行了规范治疗,但仍有复发并诱发腹膜炎的倾向,这使得有必要拔除PC并改变透析治疗模式和/或在另一部位重新插入导管,以保留PD作为一种治疗方法。在本研究中,我们讨论了一例53岁终末期肾病患者,接受PD治疗,PC出口部位出现褥疮样改变;这种改变是由于导管中部从腹腔突出至皮肤导致迁移,从而出现溃疡。尽管按照外科医生的建议对PC部位进行了抗生素治疗,但由于未对导管进行重新定位,患者最终转至血液透析。由此得出结论,抗生素治疗和导管重新定位对于保留腹膜透析作为终末期肾病(ESKD)的治疗模式是必不可少的。

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