Dapena F, Selgas R, Garcia-Perea A, Del Peso G, Bajo M A, Fernandez Reyes M J, Jimenez C, Sánchez C, Muñoz I, De Alvaro F
Servicio de Nefrologia, Hospital la Paz, Madrid, Spain.
Nephrol Dial Transplant. 1994;9(12):1774-7.
We have assessed the clinical significance of exit-site infections secondary to Xanthomonas maltophilia in continuous ambulatory peritoneal dialysis (CAPD) patients, and compared them with episodes due to Pseudomonas. The study was a retrospective survey of all episodes of Xanthomonas and Pseudomonas-related exit-site infections (ESI) in all patients treated in our unit between 1984 and 1992. Thirteen episodes of Xanthomonas-related ESI were observed in eight patients and 17 episodes of Pseudomonas-related ESI were seen in 15 patients. Xanthomonas-related ESI was frequently associated with other microorganisms, while Pseudomonas-related ESI was not (66% versus 5%, P < 0.02). Only one episode of Xanthomonas-related ESI resulted in peritonitis and subsequent catheter removal, after 15 months of resistant colonization. Another case was considered to be chronic and indolent, as the Xanthomonas-related ESI continued after 23 months of local treatment. The other 11 episodes were resolved either without treatment or with an antibiotic cream after 7-120 days. However, all but two episodes of Pseudomonas-related ESI required intravenous antibiotics (usually ceftazidime); seven patients developed peritonitis, and 11 required surgical catheter manipulation (five external cuff extrusion, and six catheter removal) (1/13 Xanthomonas-related versus 11/17 Pseudomonas-related ESI, P < 0.03). Most Xanthomonas-related ESI do not lead to peritonitis, and constitute a mild condition, easily treatable without parenteral antibiotics or catheter replacement. The appearance of other associated organisms and the favourable evolution with local treatment suggest a saprophytic behaviour for Xanthomonas in our CAPD patients. On the contrary, Pseudomonas-related ESI is usually severe, requires parenteral antibiotics, frequently leads to peritonitis, and requires catheter replacement.
我们评估了嗜麦芽窄食单胞菌所致的出口处感染在持续性非卧床腹膜透析（CAPD）患者中的临床意义，并将其与铜绿假单胞菌所致的感染情况进行了比较。本研究是一项回顾性调查，涵盖了1984年至1992年间在我们科室接受治疗的所有患者中，与嗜麦芽窄食单胞菌和铜绿假单胞菌相关的出口处感染（ESI）的所有病例。在8例患者中观察到13例与嗜麦芽窄食单胞菌相关的ESI，在15例患者中发现了17例与铜绿假单胞菌相关的ESI。与嗜麦芽窄食单胞菌相关的ESI常与其他微生物相关，而与铜绿假单胞菌相关的ESI则不然（66%对5%，P<0.02）。在15个月的耐药定植后，仅有1例与嗜麦芽窄食单胞菌相关的ESI导致腹膜炎及随后的导管拔除。另一例被认为是慢性和惰性的，因为在局部治疗23个月后，与嗜麦芽窄食单胞菌相关的ESI仍持续存在。其他11例在7至120天后未经治疗或使用抗生素乳膏后得到缓解。然而，除2例之外，所有与铜绿假单胞菌相关的ESI均需要静脉使用抗生素（通常为头孢他啶）；7例患者发生腹膜炎，11例需要进行手术导管操作（5例外部袖套挤出，6例导管拔除）（与嗜麦芽窄食单胞菌相关的ESI为1/13，与铜绿假单胞菌相关的ESI为11/17，P<0.03）。大多数与嗜麦芽窄食单胞菌相关的ESI不会导致腹膜炎，且病情较轻，无需胃肠外使用抗生素或更换导管即可轻松治疗。其他相关微生物的出现以及局部治疗后的良好转归表明，在我们的CAPD患者中，嗜麦芽窄食单胞菌表现为腐生行为。相反，与铜绿假单胞菌相关的ESI通常较为严重，需要胃肠外使用抗生素，常导致腹膜炎，并需要更换导管。
