Piraino B
Renal Electrolyte Division, University of Pittsburgh School of Medicine, PA, USA.
Adv Ren Replace Ther. 1996 Jul;3(3):222-7. doi: 10.1016/s1073-4449(96)80025-2.
Peritoneal catheter exit-site and tunnel infections may lead to peritonitis and catheter loss. Exit-site infections are diagnosed when there is pericatheter erythema and/or purulent drainage. Staphylococcus aureus is the most common cause of both exit-site and tunnel infections. S. aureus nasal carriage is an important risk factor for S. aureus catheter infections. Few other risk factors for catheter infections have been identified. Treatment of catheter infections consists of antibiotic therapy, often prolonged, as well as intensification of exit-site care. Refractory cases may resolve with revision of the tunnel and exit-site with removal of the superficial cuff, but some patients undergoing this procedure will develop peritonitis. Once peritonitis develops from a tunnel infection, the catheter should be replaced. Research on prevention of catheter infections has focused on three areas: antibiotic prophylaxis, exit-site care, and new catheter designs. Several antibiotic protocols, including intranasal mupirocin, cyclical oral rifampin, and exit-site mupirocin, are effective in decreasing S. aureus catheter infections and should be used more widely. New catheter designs may, in the future, prove to further diminish catheter infection and loss, but there are insufficient data at this time to show superiority of one catheter over another.
腹膜透析导管出口处及隧道感染可能导致腹膜炎及导管丢失。当导管周围出现红斑和/或脓性引流物时，可诊断为出口处感染。金黄色葡萄球菌是出口处及隧道感染最常见的病因。金黄色葡萄球菌鼻腔携带是金黄色葡萄球菌导管感染的重要危险因素。已确定的导管感染其他危险因素较少。导管感染的治疗包括抗生素治疗（通常疗程较长）以及加强出口处护理。难治性病例可能通过修整隧道和出口处并去除浅表袖套而治愈，但一些接受此手术的患者会发生腹膜炎。一旦因隧道感染发生腹膜炎，应更换导管。导管感染预防研究主要集中在三个方面：抗生素预防、出口处护理及新型导管设计。几种抗生素方案，包括鼻内使用莫匹罗星、周期性口服利福平及出口处使用莫匹罗星，在减少金黄色葡萄球菌导管感染方面有效，应更广泛应用。新型导管设计未来可能进一步减少导管感染及丢失，但目前尚无足够数据表明一种导管优于另一种。
