Piraino B, Bernardini J, Holley J L, Perlmutter J A
Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Perit Dial Int. 1993;13(3):194-7.
We hypothesized that the infection rates and organisms would differ in long-term peritoneal dialysis (PD) patients versus those who died or transferred to hemodialysis during the first 4 years on PD.
Data on PD-related infections and outcome were collected from 1979 to 1991 (prospectively since 1982).
The patients were followed at University and Veterans Administration dialysis centers.
All patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) for 4 years or more (n = 43) were compared to those patients who died or transferred to hemodialysis prior to 4 years on PD (n = 213).
Infection rates due to various microorganisms and reasons for transfer to hemodialysis were examined.
Peritonitis rates were 1.2/year versus 0.8/year (p < 0.001) in patients on peritoneal dialysis less than 4 years compared to those on 4 years or more, respectively, a difference due to S. epidermidis (0.32/year vs 0.20/year, p = 0.0001) and gram-negative rods other than P. aeruginosa (0.15/year versus 0.06/year, p < 0.001). Exit-site infection rates were 1.2/year versus 0.7/y (p < 0.0001) in the patients on less than 4 years compared to those on 4 years or more, respectively, a difference in part due to S. aureus (0.45/year vs 0.3/year, p < 0.001) and other gram-positive organisms (0.28/year vs 0.10/year, p < 0.001). The rates of infections that were similar in the two groups were tunnel infections (0.2/year), P. aeruginosa infections, and S. aureus peritonitis (0.18/year vs 0.14/year, p = 0.09). S. aureus was the most common cause of exist-site and tunnel infections in both groups. Forty-two percent of the patients on PD 4 years or more subsequently transferred to hemodialysis, most often due to infections, especially S. aureus.
Although infection rates are lower in patients on peritoneal dialysis 4 years or more, S. aureus and P. aeruginosa continue to account for a high proportion of the infections. Improvement in technique survival will require prevention of these infections.
我们推测长期腹膜透析（PD）患者与在PD治疗的前4年中死亡或转为血液透析的患者相比，感染率和感染微生物会有所不同。
收集1979年至1991年（自1982年起为前瞻性研究）与PD相关的感染及转归数据。
在大学和退伍军人管理局透析中心对患者进行随访。
将所有接受持续非卧床腹膜透析（CAPD）或持续循环腹膜透析（CCPD）4年及以上的患者（n = 43）与那些在PD治疗4年之前死亡或转为血液透析的患者（n = 213）进行比较。
检查各种微生物引起的感染率以及转为血液透析的原因。
腹膜透析时间少于4年的患者与4年及以上的患者相比，腹膜炎发生率分别为每年1.2次和每年0.8次（p < 0.001），差异归因于表皮葡萄球菌（每年0.32次对每年0.20次，p = 0.0001）和除铜绿假单胞菌外的革兰氏阴性杆菌（每年0.15次对每年0.06次，p < 0.001）。腹膜透析时间少于4年的患者与4年及以上的患者相比，出口处感染率分别为每年1.2次和每年0.7次（p < 0.0001），部分差异归因于金黄色葡萄球菌（每年0.45次对每年0.3次，p < 0.001）和其他革兰氏阳性菌（每年0.28次对每年0.10次，p < 0.001）。两组中相似的感染率为隧道感染（每年0.2次）、铜绿假单胞菌感染和金黄色葡萄球菌性腹膜炎（每年0.18次对每年0.14次，p = 0.09）。金黄色葡萄球菌是两组出口处和隧道感染的最常见原因。4年及以上接受PD治疗的患者中有42%随后转为血液透析，最常见的原因是感染，尤其是金黄色葡萄球菌感染。
尽管腹膜透析4年及以上患者的感染率较低，但金黄色葡萄球菌和铜绿假单胞菌仍占感染的很大比例。提高技术生存率需要预防这些感染。
