Bouza P, García Falcón T, Pérez Fontán M, Rodríguez-Carmona A, López Vázquez M, Tresancos C, Valdés F
Nephrology Unit, Hospital Juan Canalejo, A Coruña, Spain.
Adv Perit Dial. 1996;12:185-8.
We present the results of a protocol of empiric monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin (CPX), with a special emphasis on the evolution of our results after seven years of continued use of this drug. One hundred and fifteen episodes of bacterial peritonitis were treated with CPX between 1988 and 1992 (group A), and 115 episodes were treated between 1993 and 1995 (group B). The etiologic spectrum of peritonitis was similar in both groups, except for a higher incidence of polymicrobial infections in group B. The clinical success rate decreased from 86.5% in group A to 75% in group B (p < 0.05). This was partly due to the high failure rate of CPX against polymicrobial peritonitis, but the success rate also tended to decrease for gram-positive and, especially, gram-negative bacteria. However, in vitro sensitivity to CPX decreased only for coagulase-negative staphylococci, remaining stable for Staphylococcus aureus and gram-negative bacteria. CPX is still a valid alternative for the treatment of CAPD-related peritonitis in our unit. However, bacterial sensitivity must be closely monitored, especially in the case of coagulase-negative staphylococci. A different therapeutic approach may be indicated if polymicrobial peritonitis is suspected.
我们展示了一项使用环丙沙星（CPX）对持续性非卧床腹膜透析（CAPD）相关腹膜炎进行经验性单一疗法方案的结果，特别强调了在持续使用该药物七年之后我们的结果变化情况。1988年至1992年期间，115例细菌性腹膜炎发作采用CPX治疗（A组），1993年至1995年期间治疗了115例发作（B组）。两组腹膜炎的病因谱相似，只是B组中微生物混合感染的发生率更高。临床成功率从A组的86.5%降至B组的75%（p<0.05）。这部分是由于CPX治疗微生物混合性腹膜炎的失败率较高，但对革兰氏阳性菌，尤其是革兰氏阴性菌的成功率也有下降趋势。然而，仅凝固酶阴性葡萄球菌对CPX的体外敏感性下降，金黄色葡萄球菌和革兰氏阴性菌的敏感性保持稳定。在我们科室，CPX仍然是治疗CAPD相关腹膜炎的一种有效选择。然而，必须密切监测细菌敏感性，尤其是在凝固酶阴性葡萄球菌感染的情况下。如果怀疑是微生物混合性腹膜炎，可能需要采取不同的治疗方法。
