Troidle L, Kliger A S, Gorban-Brennan N, Fikrig M, Golden M, Finkelstein F O
New Haven CPD, Department of Internal Medicine, Connecticut, USA.
Kidney Int. 1996 Oct;50(4):1368-72. doi: 10.1038/ki.1996.451.
Nine episodes of chronic peritoneal dialysis (CPD)-associated peritonitis with vancomycin resistant enterococci (VRE) were described between November 1993 and February 1996 in our dialysis unit. During the time period, 216 patients were treated for 227 episodes of peritonitis. Of the patients developing peritonitis with VRE the mean age +/- SD was 56.3 +/- 9.7 years. There were 5 females, 4 males, 5 Caucasians and 4 African-Americans. Diabetes mellitus, cardiovascular disease and gastrointestinal disease were present in 7, 8 and 7 of the 9 patients with VRE peritonitis, respectively. Patients were maintained on CPD therapy for an average of 29.9 +/- 19.2 patient months before developing VRE peritonitis. The prior rate of CPD associated peritonitis in the patients developing VRE peritonitis was significantly higher than the rate noted in the CPD patients not developing peritonitis with VRE (1 episode in 6.3 patient months vs. 1 episode in 12.5 patient months, P < 0.05). All 9 patients had used vancomycin in the six months prior to the development of VRE peritonitis and 78% had used a cephalosporin. The antimicrobial therapy used to eradicate peritonitis with VRE varied among the 9 patients with chloramphenicol used in 4 patients. The Tenckhoff catheter was removed in 6 of the 9 patients and was successfully reinserted in one patient. The catheter was not removed in 3 patients and 2 of these patients expired. Five of the 9 patients expired while being treated for VRE, 2 transferred to hemodialysis and 2 continued CPD therapy. VRE peritonitis is a major concern for patients maintained on CPD therapy. Future studies are needed with case controls to determine the significance of prior vancomycin and cephalosporin therapy, fecal VRE carriage and certain demographic data on the acquisition of VRE peritonitis. Furthermore, the optimal therapy and outcome may be better clarified through such a review.
1993年11月至1996年2月期间，我们透析单元共出现9例慢性腹膜透析（CPD）相关的耐万古霉素肠球菌（VRE）腹膜炎。在此期间，216例患者共发生227次腹膜炎。发生VRE腹膜炎的患者平均年龄±标准差为56.3±9.7岁。其中女性5例，男性4例，白种人5例，非裔美国人4例。9例VRE腹膜炎患者中，分别有7例、8例和7例患有糖尿病、心血管疾病和胃肠道疾病。患者在发生VRE腹膜炎前平均接受CPD治疗29.9±19.2个患者月。发生VRE腹膜炎的患者中，CPD相关腹膜炎的既往发生率显著高于未发生VRE腹膜炎的CPD患者（每6.3个患者月1次 vs. 每12.5个患者月1次，P<0.05）。所有9例患者在发生VRE腹膜炎前6个月内均使用过万古霉素，78%的患者使用过头孢菌素。9例患者中用于根除VRE腹膜炎的抗菌治疗各不相同，4例患者使用了氯霉素。9例患者中有6例拔除了Tenckhoff导管，其中1例成功重新置管。3例患者未拔除导管，其中2例死亡。9例患者中有5例在治疗VRE期间死亡，2例转为血液透析，2例继续接受CPD治疗。VRE腹膜炎是接受CPD治疗患者的主要担忧。未来需要进行病例对照研究，以确定既往万古霉素和头孢菌素治疗、粪便VRE携带情况以及某些人口统计学数据对VRE腹膜炎发生的影响。此外，通过这样的综述可能会更好地阐明最佳治疗方法和预后。
