Klaus G, Schaefer F, Müller-Wiefel D, Mehls O
Department of Pediatrics, University of Heidelberg, Germany.
Adv Perit Dial. 1995;11:296-301.
A recent treatment update for continuous peritoneal dialysis (CPD)-associated peritonitis recommends first-line use of continuously or intermittently administered intraperitoneal vancomycin and ceftazidine. Teicoplanin has recently been introduced as a potentially less toxic alternative glycopeptide antibiotic. However, efficacy and safety have not been demonstrated for intermittent treatment schedules or for the use of teicoplanin in prospective studies. Therefore, a prospective trial on the treatment of CPD-associated peritonitis was started in 15 pediatric dialysis units using vancomycin or teicoplanin, in combination with ceftazidine. Vancomycin or teicoplanin was administered either continuously with each bag of dialysate for 10 days or as a single dose on days 1 and 8, and ceftazidime either continuously or in one bag of dialysate per day. Until December 31, 1994, 81 episodes of peritonitis including 16 relapses occurred in a cohort of 120 patients. The incidence of peritonitis was 1 episode/13.7 months, regardless of treatment modality [continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD)]. Thirty-six (57%) primary peritonitis episodes were caused by staphylococci (21 Staphylococcus aureus, 15 coagulase-negative), 12 (19%) by gram-negative bacteria, 7 by other germs, and in 8 (13%) cases cultures remained sterile. Primary treatment response was achieved in 43/46 (93%) gram-positive and 4/12 (33%) gram-negative peritonitis episodes. Relapses occurred only with gram-positive bacteria (16/63, 25%). In cases of gram-positive peritonitis, no differences in primary response (25/25 vs 15/18) or relapse rates (10/36 vs 6/27) were observed between groups on continuous and intermittent treatment, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
最近关于持续性腹膜透析（CPD）相关腹膜炎的治疗更新建议将持续或间歇腹腔内使用万古霉素和头孢他啶作为一线治疗方法。替考拉宁最近作为一种潜在毒性较小的替代糖肽类抗生素被引入。然而，在前瞻性研究中，间歇性治疗方案或替考拉宁的使用的疗效和安全性尚未得到证实。因此，15个儿科透析单位开展了一项关于CPD相关腹膜炎治疗的前瞻性试验，使用万古霉素或替考拉宁联合头孢他啶。万古霉素或替考拉宁与每袋透析液连续使用10天，或在第1天和第8天单次给药，头孢他啶则连续使用或每天在一袋透析液中使用。截至1994年12月31日，120名患者队列中发生了81例腹膜炎，包括16例复发。无论治疗方式如何[持续非卧床腹膜透析（CAPD）或持续循环腹膜透析（CCPD）]，腹膜炎的发生率为1次/13.7个月。36例（57%）原发性腹膜炎由葡萄球菌引起（21例金黄色葡萄球菌，15例凝固酶阴性），12例（19%）由革兰氏阴性菌引起，7例由其他病菌引起，8例（13%）培养结果无菌。46例革兰氏阳性腹膜炎中有43例（93%）、12例革兰氏阴性腹膜炎中有4例（33%）实现了初始治疗反应。复发仅发生在革兰氏阳性菌感染中（16/63，25%）。在革兰氏阳性腹膜炎病例中，连续治疗组和间歇治疗组之间在初始反应（25/25 vs 15/18）或复发率（10/36 vs 6/27）方面均未观察到差异。（摘要截断于250字）
