Bunke C M, Brier M E, Golper T A
Division of Nephrology, MUSC Medical Center, Charleston, South Carolina, USA.
Kidney Int. 1997 Aug;52(2):524-9. doi: 10.1038/ki.1997.363.
The use of the "peritonitis rate" in the management of patients undergoing peritoneal dialysis is assuming importance in comparing the prowess of facilities, care givers and new innovations. For this to be a meaningful outcome measure, the type of infection (causative pathogen) must have less clinical significance than the number of infections during a time interval. The natural history of Staphylococcus aureus, pseudomonas, and fungal peritonitis would not support that the outcome of an episode of peritonitis is independent of the causative pathogen. Could this concern be extended to other more frequently occurring pathogens? To address this, the Network 9 Peritonitis Study identified 530 episodes of single organism peritonitis caused by a gram positive organism and 136 episodes caused by a single non-pseudomonal gram negative (NPGN) pathogen. Coincidental soft tissue infections (exit site or tunnel) occurred equally in both groups. Outcomes of peritonitis were analyzed by organism classification and by presence or absence of a soft tissue infection. NPGN peritonitis was associated with significantly more frequent catheter loss, hospitalization, and technique failure and was less likely to resolve regardless of the presence or absence of a soft tissue infection. Hospitalization and death tended to occur more frequently with enterococcal peritonitis than with other gram positive peritonitis. The outcomes in the NPGN peritonitis group were significantly worse (resolution, catheter loss, hospitalization, technique failure) compared to coagulase negative staphylococcal or S. aureus peritonitis, regardless of the presence or absence of a coincidental soft tissue infection. Furthermore, for the first time, the poor outcomes of gram negative peritonitis are shown to be independent of pseudomonas or polymicrobial involvement or soft tissue infections. The gram negative organism appears to be the important factor. In addition, the outcome of peritonitis caused by S. aureus is worse than that of other staphylococci. Thus, it is clear that all peritonitis episodes cannot be considered equivalent in terms of outcome. The concept of peritonitis rate is only meaningful when specific organisms are considered.
在腹膜透析患者的管理中，“腹膜炎发生率”对于比较不同机构、护理人员和新创新技术的水平正变得越来越重要。要使其成为一个有意义的结果指标，感染类型（致病病原体）的临床意义必须小于某一时间段内感染的数量。金黄色葡萄球菌、假单胞菌和真菌性腹膜炎的自然病史并不支持腹膜炎发作的结果与致病病原体无关这一观点。这种担忧能否扩展到其他更常见的病原体呢？为了解决这个问题，腹膜透析网络9腹膜炎研究确定了530例由革兰氏阳性菌引起的单一微生物腹膜炎病例和136例由单一非假单胞菌革兰氏阴性（NPGN）病原体引起的病例。两组中同时发生的软组织感染（出口部位或隧道感染）情况相同。根据病原体分类以及是否存在软组织感染对腹膜炎的结果进行了分析。NPGN腹膜炎与导管丢失、住院和技术失败的发生率显著更高相关，并且无论是否存在软组织感染，其缓解的可能性都较小。与其他革兰氏阳性腹膜炎相比，肠球菌性腹膜炎导致住院和死亡的频率往往更高。与凝固酶阴性葡萄球菌或金黄色葡萄球菌腹膜炎相比，无论是否存在同时发生的软组织感染，NPGN腹膜炎组的结果（缓解、导管丢失、住院、技术失败）都显著更差。此外，首次表明革兰氏阴性腹膜炎的不良结果与假单胞菌或多微生物感染或软组织感染无关。革兰氏阴性菌似乎是重要因素。此外，金黄色葡萄球菌引起的腹膜炎结果比其他葡萄球菌引起的更差。因此，很明显，就结果而言，不能认为所有腹膜炎发作都是等效的。只有在考虑特定病原体时，腹膜炎发生率的概念才有意义。
