Keane W F, Comty C M, Verbrugh H A, Peterson P K
Kidney Int. 1984 Mar;25(3):539-43. doi: 10.1038/ki.1984.51.
Staphylococcus epidermidis peritonitis frequently complicates the clinical course of patients treated with continuous ambulatory peritoneal dialysis (CAPD). Since bacterial opsonization is critical to the effective defense of the peritoneal cavity by phagocytic cells, we prospectively evaluated the opsonic activity of peritoneal dialysis effluent obtained from 17 CAPD patients during 102 patient months. Samples of peritoneal dialysis effluent contained concentrations of opsonins against S. epidermidis that were less than 2% of that observed in serum. Moreover, heat-labile opsonic activity against Escherichia coli was absent from all dialysis effluents. During the study, there were ten episodes of peritonitis in nine CAPD patients (1 per 10.2 patient months). S. epidermidis was isolated in seven episodes, a gram-negative bacillus in one, and two episodes were culture negative. the incidence of S. epidermidis peritonitis was 1 per 62 patient months in the patients with "high" peritoneal dialysis effluent opsonic activity against S. epidermidis but was nearly tenfold greater in patients with "low" opsonic activity (1 per 6.7 patient months). We conclude that peritoneal dialysis effluent opsonic activity predicts which CAPD patients are at an increased risk to develop S. epidermidis peritonitis.
表皮葡萄球菌腹膜炎常使接受持续性非卧床腹膜透析（CAPD）治疗的患者临床病程复杂化。由于细菌调理素化对于吞噬细胞有效防御腹膜腔至关重要，我们前瞻性评估了17例CAPD患者在102个患者月期间获得的腹膜透析流出液的调理活性。腹膜透析流出液样本中针对表皮葡萄球菌的调理素浓度低于血清中观察到浓度的2%。此外，所有透析流出液均缺乏针对大肠杆菌的热不稳定调理活性。在研究期间，9例CAPD患者发生了10次腹膜炎发作（每10.2个患者月1次）。7次发作分离出表皮葡萄球菌，1次分离出革兰氏阴性杆菌，2次培养阴性。在腹膜透析流出液对表皮葡萄球菌具有“高”调理活性的患者中，表皮葡萄球菌腹膜炎的发生率为每62个患者月1次，但在调理活性“低”的患者中几乎高出10倍（每6.7个患者月1次）。我们得出结论，腹膜透析流出液调理活性可预测哪些CAPD患者发生表皮葡萄球菌腹膜炎的风险增加。
