Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis
Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis
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DOI：
10.1053/ajkd.2002.33403
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发表时间：
2002-06-01
影响因子：
13.2
通讯作者：
Bia, FJ
中科院分区：
文献类型：
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作者：
Finkelstein, ES;Jekel, J;Bia, FJ
长期腹膜透析（PD）终末期肾病患者发生腹膜炎的原因尚不清楚。腹膜炎的一种可能的解释，特别是在多次感染的患者中，是从导管壁上的生物膜中释放出嗜酸性细菌。细菌在导管放置后48小时内在导管壁上形成生物膜。如果这种解释是正确的，那么可以预期在多次腹膜炎患者中会再次出现引起感染的微生物。对1990年1月1日至2000年7月31日在纽黑文CAPD开始长期PD的所有患者的图表进行了审查。如果患者经历了一次以上的培养阳性腹膜炎发作，并且可以获得关于培养微生物和抗生素敏感性模式的完整数据，则将其纳入研究。审查了感染、微生物、敏感性和导管更换的发生率。在630名患者中，198名被确定为符合这些标准。男性114例，白色患者104例。在198例患者中，157例（80%）至少有一次相同微生物的重复感染。在124例（79%）患者中，超过50%的腹膜炎发作是由同一种微生物引起的。在90名有4次以上感染史的患者中，59名（65%）至少有一半或更多的感染是由同一种微生物引起的。独立性的序贯分析显示，对于表皮葡萄球菌和金黄色葡萄球菌，这些微生物作为腹膜炎致病微生物的可能性显著增加。当使用斯皮尔曼相关性检验对数据进行分析时，结果表明重复感染发生的可能性显著大于单独的偶然性。在67例更换导管并随后发生腹膜炎的患者中，只有10例（15%）在更换导管后发生了相同微生物的重复感染。其中八个是由于酵母。这些数据支持以下假设：腹膜导管壁上的细菌生物膜可能与长期PD患者的腹膜炎相关，并可能导致至少部分感染发作。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
The causes of peritonitis in patients with end-stage renal disease maintained on long-term peritoneal dialysis (PD) are unclear. One possible explanation for peritonitis, particularly in patients with multiple episodes of infection, is the release of planktonic bacteria from biofilm on the walls of catheters. Bacteria form biofilm on the walls of catheters within 48 hours of their placement. If this explanation were correct, one would expect there to be reappearance of organisms causing infection in patients with multiple episodes of peritonitis. The charts of all patients starting long-term PD at New Haven CAPD from January 1, 1990, through July 31, 2000, were reviewed. Patients were included in the study if they had experienced more than one episode of culture-positive peritonitis and complete data were available concerning cultured organisms and antibiotic sensitivity patterns. Episodes of infection, organisms, and sensitivities and catheter changes were reviewed. Of 630 patients, 198 were identified as meeting these criteria. There were 114 men; 104 patients were white. Of 198 patients, 157 (80%) had at least one repeat infection with the same organism. In 124 (79%) patients, more than 50% of the peritonitis episodes were caused by the same organism. Of 90 patients who had more than four episodes of infection in their history, 59 (65%) had at least half or more of their episodes caused by the same organism. Sequential analyses for independence revealed that for Staphylococcus epidermidis and for Staphylococcus aureus, there was a significantly increased likelihood for these organisms to follow themselves as causative organisms of peritonitis. When the data were analyzed using the Spearman correlation test, the results indicated that the likelihood of repeat infections occurring was significantly greater than by chance alone. Of 67 patients with catheter changes and subsequent peritonitis, only 10 (15%) developed repeat infections with the same organism after the catheter change. Eight of these were due to yeast. These data support the hypothesis that bacterial biofilm on the walls of peritoneal catheters may be associated with peritonitis in patients maintained on long-term PD and may contribute to at least some of these episodes of infection. (C) 2002 by the National Kidney Foundation, Inc.