El-Shahawy M A, Kim D, Gadallah M F
Division of Nephrology, University of Southern California School of Medicine, Los Angeles, CA 90033, USA.
Am J Nephrol. 1998;18(5):452-5. doi: 10.1159/000013370.
Despite significant progress to decrease its incidence, peritonitis remains the main source of morbidity and treatment failure in patients on continuous ambulatory peritoneal dialysis (CAPD). The majority of cases of peritonitis result from infection with aerobic gram-positive (Staphylococcus epidermidis and Staphylococcus aureus), or gram-negative organisms. Less common organisms that are also reported include anaerobic bacteria, fungi, and mycobacteria, which collectively account for less than 10% of isolates cultured. We report a case of peritoneal dialysis-associated peritonitis, and review the literature on peritonitis caused by Alcaligenes species. Alcaligenes xylosoxidans is a nonfermenting gram-negative rod and opportunistic pathogen that is motile with peritrichous flagella. The clinical features and microbiological data of our case, as well as the other previously reported cases of peritonitis caused by Alcaligenes species show no particular pattern of peritoneal dialysate cell count. However, the rate of recurrence of peritonitis is characteristically high. The cause of such a high rate of recurrence of peritonitis is probably a reflection of the predilection of Alcaligenes species to cause infection in the 'sicker' patients, and the almost universal resistance of this species to most antimicrobial agents. We, therefore, recommend that catheter removal be undertaken as early as the identification of the organism is made. Whether patients should be allowed to return to CAPD after recovery is a more difficult question. We suggest that a reevaluation of the patient's overall status be undertaken, including personal hygiene, exchange technique, presence of diabetes mellitus, malnutrition, and/or other factors that may render the patient more prone to infection with opportunistic pathogens.
尽管在降低其发病率方面取得了显著进展，但腹膜炎仍然是持续性非卧床腹膜透析（CAPD）患者发病和治疗失败的主要原因。大多数腹膜炎病例是由需氧革兰氏阳性菌（表皮葡萄球菌和金黄色葡萄球菌）或革兰氏阴性菌感染引起的。报告中较少见的病原体还包括厌氧菌、真菌和分枝杆菌，它们总共占培养分离菌的不到10%。我们报告一例腹膜透析相关性腹膜炎病例，并回顾有关产碱杆菌属引起的腹膜炎的文献。木糖氧化产碱杆菌是一种不发酵的革兰氏阴性杆菌，是一种机会致病菌，有周鞭毛能运动。我们病例的临床特征和微生物学数据，以及先前报告的其他产碱杆菌属引起的腹膜炎病例，均未显示出腹膜透析液细胞计数的特定模式。然而，腹膜炎的复发率通常很高。腹膜炎如此高复发率的原因可能反映了产碱杆菌属倾向于在病情较重的患者中引起感染，以及该菌对大多数抗菌药物几乎普遍耐药。因此，我们建议一旦确定病原体，应尽早拔除导管。患者康复后是否应允许重新进行CAPD是一个更难的问题。我们建议对患者的整体状况进行重新评估，包括个人卫生、换液技术、是否存在糖尿病、营养不良和/或其他可能使患者更容易感染机会致病菌的因素。
