Lo C Y, Chu W L, Wan K M, Ng S Y, Lee W L, Chu M F, Cheng S W, Lo W K
Department of Medicine, Tung Wah Hospital, Hong Kong.
Perit Dial Int. 1998 Nov-Dec;18(6):637-40.
To examine the natural history of Pseudomonas aeruginosa (PSA) exit-site infections (ESI) in patients treated with antibiotics with or without surgical interventions.
Retrospective record review from May 1994 to April 1997.
A single dialysis unit in a district hospital.
The review included 353 patients who had undergone continuous ambulatory peritoneal dialysis (CAPD).
The prevalence and etiology of ESI, the treatment regimen for PSA ESI, and the outcome of treatment.
The prevalence of ESI was 55%. A total of 131 episodes (range 1-5) of PSA ESI occurred in 78 (40.2%) of the 194 patients who experienced ESI. Among these 78 patients, 4 groups with different outcomes were identified. In group I, 35 patients (44.9%) were treated successfully with antibiotic therapy alone. Among these 35 patients, 4 developed PSA peritonitis at a mean of 5 months (range 2-10 mth) after apparent clinical resolution of PSA ESI. Two of the 4 patients switched to long-term hemodialysis (HD) because of peritoneal failure. In group II, 8 patients (10.3%) responded to a combination of antibiotics and shaving of the external cuff. In group III, 21 patients (26.9%) with recurrent ESI underwent elective Tenckhoff catheter removal and reinsertion. One of the 21 patients had relapse of PSA ESI 14 months after the operation. In group IV, 14 patients (17.9%) had recurrent PSA ESI that failed to respond to multiple courses of antibiotics and shaving of the external cuff. Consent for Tenckhoff catheter removal was not obtained and 4 of these 14 patients subsequently developed PSA peritonitis. One of the 4 patients changed to permanent HD due to peritoneal failure.
Considering the increased risk and the poor outcome of PSA peritonitis in patients with persistent PSA ESI, early Tenckhoff catheter removal is recommended if the patient fails to respond to antibiotics with or without externalization of the external cuff.
研究接受抗生素治疗（无论有无手术干预）的铜绿假单胞菌（PSA）出口部位感染（ESI）患者的自然病史。
对1994年5月至1997年4月的病历进行回顾性研究。
一家地区医院的单个透析单元。
该回顾性研究纳入了353例行持续性非卧床腹膜透析（CAPD）的患者。
ESI的患病率及病因、PSA ESI的治疗方案以及治疗结果。
ESI的患病率为55%。在194例发生ESI的患者中，78例（40.2%）共发生了131次（范围为1 - 5次）PSA ESI发作。在这78例患者中，确定了4组不同结局。在第一组中，35例患者（44.9%）仅接受抗生素治疗即成功治愈。在这35例患者中，4例在PSA ESI临床症状明显缓解后平均5个月（范围为2 - 10个月）发生了PSA腹膜炎。4例患者中有2例因腹膜衰竭转为长期血液透析（HD）。在第二组中，8例患者（10.3%）对抗生素联合外部袖套修剪治疗有反应。在第三组中，21例反复发生ESI的患者接受了择期Tenckhoff导管拔除并重新插入。21例患者中有1例在术后14个月出现PSA ESI复发。在第四组中，14例患者（17.9%）反复发生PSA ESI，对多疗程抗生素及外部袖套修剪治疗均无反应。未获得Tenckhoff导管拔除的同意，这14例患者中有4例随后发生了PSA腹膜炎。4例患者中有1例因腹膜衰竭改为永久性HD。
鉴于持续性PSA ESI患者发生PSA腹膜炎的风险增加且结局不佳，如果患者对抗生素治疗（无论有无外部袖套外置）无反应，建议早期拔除Tenckhoff导管。
