Peritonitis associated with exit site and tunnel infections
Peritonitis associated with exit site and tunnel infections
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DOI：
10.1016/s0272-6386(96)90500-4
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发表时间：
1996-09-01
影响因子：
13.2
通讯作者：
Piraino, B
中科院分区：
文献类型：
--
作者：
Gupta, B;Bernardini, J;Piraino, B
我们回顾了所有与出口部位和/或隧道感染相关的腹膜炎发作（n = 87;速率，0.1/年; 1979年至1995年发生的所有腹膜炎事件的13%），66%的事件在患者出现腹膜炎时或之后不久诊断出出口部位或隧道感染，在另外三分之一的患者中，出口部位或隧道感染是在腹膜炎发生前40天（中位数）诊断的。金黄色葡萄球菌占52%，其次是铜绿假单胞菌，63例（72%）患者在中位8天内拔除导管以解决感染（范围，0 - 226天），5天后拔除导管主要用于难治性腹膜炎（n = 23;中位取出时间，8天）或复发性腹膜炎（n = 11;导管移除的中位时间，103天），复发性腹膜炎患者在移除导管之前经历2 - 4次发作，与隧道感染相关的腹膜炎患者比与出口部位感染相关的腹膜炎患者更容易丢失导管（86%对58%），而表皮葡萄球菌感染与所有其他微生物相比不太可能导致导管丢失（15%对82%），在1990年实施减少金黄色葡萄球菌导管感染的方案后，由于金黄色葡萄球菌事件的减少，导管相关性腹膜炎的发生率从0.14/年降至0.05/年。我们的结论是，与隧道感染相关的腹膜炎发作很少在不拔除导管的情况下消退，在这种情况下延迟拔除导管通常会导致难治性或复发性腹膜炎，因此，应及时拔除导管，预防金黄色葡萄球菌的抗生素可以减少导管相关性腹膜炎。(C)1996年由国家肾脏基金会，公司。
We reviewed all episodes of peritonitis associated with exit site and/or tunnel infection (n = 87; rate, 0.1/yr; 13% of all peritonitis episodes) occurring from 1979 to 1995, The exit site or tunnel infection was diagnosed at the time or shortly after the patient presented with peritonitis in 66% of the episodes, In the other one third the exit site or tunnel infection was diagnosed a median of 40 days prior to the development of peritonitis. Staphylococcus aureus accounted for 52% of episodes, Pseudomonas aeruginosa was the next most common organism, In 63 (72%) of the episodes the catheter was removed to resolve the infection at a median of 8 days (range, 0 to 226 days) from the onset of peritonitis, Catheter removal after 5 days was predominately for refractory peritonitis (n = 23; median time to removal, 8 days) or relapsing peritonitis (n = 11; median time to catheter removal, 103 days), Patients with relapsing peritonitis suffered two to four episodes prior to removal of the catheter, Patients with peritonitis associated with tunnel infection were more likely to lose their catheter than patients with peritonitis associated with exit site infection (86% v 58%), while Staphylococcus epidermidis infections were less likely to result in catheter loss compared with all other organisms (15% v 82%), After a protocol to reduce S aureus catheter infections was implemented in 1990, the rate of catheter-related peritonitis decreased from 0.14/yr to 0.05/yr due to a decrease in S aureus episodes. We conclude that peritonitis episodes associated with a tunnel infection infrequently resolve without catheter removal, Delayed catheter removal in such circumstances often results in refractory or relapsing peritonitis, Therefore, catheter removal should be done promptly, Antibiotic prophylaxis for S aureus can reduce catheter-related peritonitis. (C) 1996 by the National Kidney Foundation, Inc.