Troidle L, Gorban-Brennan N, Kliger A, Finkelstein F
New Haven Chronic Peritoneal Dialysis, Renal Research Institute, Yale University School of Medicine, CT, USA.
Am J Kidney Dis. 1998 Oct;32(4):623-8. doi: 10.1016/s0272-6386(98)70026-5.
Peritonitis remains the leading cause of patient dropout from continuous peritoneal dialysis (CPD) therapy. Few studies have compared patient morbidity, mortality, and outcome for patients undergoing CPD who develop gram-positive and gram-negative peritonitis. We retrospectively reviewed the charts of patients who developed either gram-positive or gram-negative peritonitis between January 1, 1993, and December 31, 1995. Three hundred seventy-five patients who developed 415 episodes of gram-positive and gram-negative peritonitis were maintained on CPD therapy during this time period. There was no difference in age, race, and sex between patients who developed gram-positive or gram-negative peritonitis. More patients with diabetes developed gram-negative peritonitis than gram-positive peritonitis (53% v 40%, respectively; P < 0.05). Coagulase-negative staphylococcal species accounted for 47% of all gram-positive episodes, whereas Klebsiella organisms, Escherichia coli, and Enterobacter organisms accounted for 63% of all gram-negative episodes. Significantly more patients who developed gram-positive peritonitis continued CPD therapy 2 weeks and 6 months after the onset of peritonitis than patients who developed gram-negative peritonitis (97% v 73%; P < 0.05 at 2 weeks and 81% v 58% at 6 months; P < 0.05, respectively). Nine percent of the patients who developed gram-positive peritonitis died within 6 months after the onset of peritonitis, whereas 21% of the patients who developed gram-negative peritonitis died (P < 0.05). Patients who developed gram-negative peritonitis were significantly more likely to require hospitalization than patients who developed gram-positive peritonitis (74% v 24%; P < 0.001). More patients with gram-negative peritonitis required peritoneal catheter removal than patients with gram-positive peritonitis (18% v 4%; P < 0.001). Thirty-two percent of the patients who developed gram-positive peritonitis re-developed an episode of peritonitis with the same organism compared with only 9% of the patients who developed gram-negative peritonitis. Furthermore, peritonitis recurrence with the same organism within 6 months after the initial episode was noted in 60% of the patients with peritonitis caused by Staphylococcus aureus compared with 24% of patients with peritonitis caused by other gram-positive organisms (P < 0.05). We conclude that the outcomes of gram-positive and gram-negative peritonitis are different. When rates of peritonitis are used to predict outcome, it appears that gram-positive and gram-negative peritonitis rates need to be examined separately.
腹膜炎仍然是持续性腹膜透析（CPD）治疗中患者退出治疗的主要原因。很少有研究比较发生革兰氏阳性和革兰氏阴性腹膜炎的CPD患者的发病率、死亡率及预后情况。我们回顾性分析了1993年1月1日至1995年12月31日期间发生革兰氏阳性或革兰氏阴性腹膜炎患者的病历。在此期间，375例发生415次革兰氏阳性和革兰氏阴性腹膜炎发作的患者接受了CPD治疗。发生革兰氏阳性或革兰氏阴性腹膜炎的患者在年龄、种族和性别方面无差异。糖尿病患者发生革兰氏阴性腹膜炎的比例高于革兰氏阳性腹膜炎（分别为53%和40%；P<0.05）。凝固酶阴性葡萄球菌占所有革兰氏阳性发作的47%，而克雷伯菌属、大肠杆菌和肠杆菌属占所有革兰氏阴性发作的63%。发生革兰氏阳性腹膜炎的患者在腹膜炎发作后2周和6个月继续接受CPD治疗的比例明显高于发生革兰氏阴性腹膜炎的患者（2周时为97%对73%；P<0.05，6个月时为81%对58%；P<0.05）。发生革兰氏阳性腹膜炎的患者中有9%在腹膜炎发作后6个月内死亡，而发生革兰氏阴性腹膜炎的患者中有21%死亡（P<0.05）。发生革兰氏阴性腹膜炎的患者比发生革兰氏阳性腹膜炎的患者更有可能需要住院治疗（74%对24%；P<0.001）。与革兰氏阳性腹膜炎患者相比，革兰氏阴性腹膜炎患者更需要拔除腹膜导管（18%对4%；P<0.001）。发生革兰氏阳性腹膜炎的患者中有32%再次发生同一病原体引起的腹膜炎发作，而发生革兰氏阴性腹膜炎的患者中只有9%。此外，金黄色葡萄球菌引起的腹膜炎患者中有60%在初次发作后6个月内复发同一病原体引起的腹膜炎，而其他革兰氏阳性病原体引起的腹膜炎患者中这一比例为24%（P<0.05）。我们得出结论，革兰氏阳性和革兰氏阴性腹膜炎的预后不同。当用腹膜炎发生率预测预后时，似乎革兰氏阳性和革兰氏阴性腹膜炎发生率需要分别进行研究。
