Gupta B, Bernardini J, Piraino B
Department of Medicine, University of Pittsburgh School of Medicine, PA 15213, USA.
Am J Kidney Dis. 1996 Sep;28(3):415-9. doi: 10.1016/s0272-6386(96)90500-4.
We reviewed all episodes of peritonitis associated with exit site and/or tunnel infection (n = 87; rate, 0.1/yr; 13% of all peritonitis episodes) occurring from 1979 to 1995. The exit site or tunnel infection was diagnosed at the time or shortly after the patient presented with peritonitis in 66% of the episodes. In the other one third the exit site or tunnel infection was diagnosed a median of 40 days prior to the development of peritonitis. Staphylococcus aureus accounted for 52% of episodes. Pseudomonas aeruginosa was the next most common organism. In 63 (72%) of the episodes the catheter was removed to resolve the infection at a median of 8 days (range, 0 to 226 days) from the onset of peritonitis. Catheter removal after 5 days predominately for refractory peritonitis (n = 23; median time to removal, 8 days) or relapsing peritonitis (n = 11; median time to catheter removal, 103 days). Patients with relapsing peritonitis suffered two to four episodes prior to removal of the catheter. Patients with peritonitis associated with tunnel infection were more likely to lose their catheter than patients with peritonitis associated with exit site infection (86% v 58%), while Staphylococcus epidermidis infections were less likely to result in catheter loss compared with all other organisms (15% v 82%). After a protocol to reduce S aureus catheter infections was implemented in 1990, the rate of catheter-related peritonitis decreased from 0.14/yr to 0.05/yr due to a decrease in S aureus episodes. We conclude that peritonitis episodes associated with a tunnel infection infrequently resolve without catheter removal. Delayed catheter removal in such circumstances often results in refractory or relapsing peritonitis. Therefore, catheter removal should be done promptly. Antibiotic prophylaxis for S aureus can reduce catheter-related peritonitis.
我们回顾了1979年至1995年间发生的所有与出口部位和/或隧道感染相关的腹膜炎病例（n = 87；发生率为0.1/年；占所有腹膜炎病例的13%）。在66%的病例中，出口部位或隧道感染是在患者出现腹膜炎时或之后不久被诊断出来的。在另外三分之一的病例中，出口部位或隧道感染是在腹膜炎发生前中位时间40天被诊断出来的。金黄色葡萄球菌占病例的52%。铜绿假单胞菌是其次最常见的病原体。在63例（72%）病例中，为解决感染问题，在腹膜炎发作后中位时间8天（范围为0至226天）拔除了导管。5天后拔除导管主要是针对难治性腹膜炎（n = 23；拔除的中位时间为8天）或复发性腹膜炎（n = 11；导管拔除的中位时间为103天）。复发性腹膜炎患者在拔除导管前经历了两到四次发作。与出口部位感染相关的腹膜炎患者相比，与隧道感染相关的腹膜炎患者更有可能失去导管（86%对58%），而与所有其他病原体相比，表皮葡萄球菌感染导致导管丢失的可能性较小（15%对82%）。1990年实施减少金黄色葡萄球菌导管感染的方案后，由于金黄色葡萄球菌病例减少，导管相关腹膜炎的发生率从0.14/年降至0.05/年。我们得出结论，与隧道感染相关的腹膜炎病例很少在不拔除导管的情况下得到解决。在这种情况下延迟拔除导管通常会导致难治性或复发性腹膜炎。因此，应及时拔除导管。针对金黄色葡萄球菌的抗生素预防可减少导管相关腹膜炎。
