腹膜透析导管置换可有效终止复发性腹膜炎的反复发作——附6例病例分析

Relapsing peritonitis in peritoneal dialysis patients can be effectively terminated by catheter exchange: Clinical experiences from 6 cases with relapsing peritonitis

目的探讨复发性腹膜炎的治疗策略。方法复发性腹膜炎是指距上次抗生素治疗完成4周内的相同致病菌感染,或培养阴性的感染。回顾分析2005年11月至2008年10月北京大学第一医院腹膜透析中心复发性腹膜炎病例,收集患者一般资料、腹膜炎症状评估、实验室检查、治疗方法和预后。结果共6例复发性腹膜炎患者,男性3例,女性3例,年龄(60±13)岁,首次腹膜炎发生时透析龄1～88个月,中位数为17.5个月。每例患者腹膜炎发生次数2～6次,共20例次。临床特点:症状轻,首次发作时腹膜炎严重程度评分(disease severity score,DSS)5例为1分,1例为0分;腹膜透析液细菌培养以表皮和金黄色葡萄球菌为主;抗菌素治疗可以快速有效控制感染,治疗3d后DSS均为0分。然而一旦停药腹膜炎仍复发,平均发作间期2.4周(4d～4周),后续发作特点同首次;6例均实施了腹膜透析管更换术,其中5例拔除旧管与插新管同时进行,1例2周后插入新管。术后至观察结束至少8个月腹膜炎均未再复发。结论尽早识别复发性腹膜炎,并在有效抗菌素控制感染基础上更换腹膜透析管是阻断腹膜炎复发的关键。

Objective To explore the treatment of peritoneal dialysis （PD）-related relapsing peritonitis. Methods Relapsing peritonitis was diagnosed when the peritonitis recurred in 4 weeks after the completion of antibiotic therapy caused by the same organism or without bacteria in bacterial culture. We retrospectively analyzed the relapsing peritonitis cases in the Peritoneal Dialysis Center, Peking University First Hospital from Nov. 2005 to Oct. 2008. Their demographic data, clinical features, laboratory findings, treatment and outcome were collected. Results The 6 relapsing peritonitis cases were 3 males and 3 females, with the median age of 60.5 - 12.8 years. Three of them were complicated with diabetes. The median dialysis vintage when they first experienced peritonitis was 17.5 （1 to 88） months. There were totally 20 episodes of peritonitis in the 6 cases, and every case had more than one episode of peritonitis. Bacterial culture for peritoneal fluid showed staphylococcus epidermidis in 3 cases and staphylococcus aureus in 2 cases. Regular antibiotics therapy was administered in the first few days of infection, and then the therapy was changed to the antibiotics sensitive to the pathogen according to laboratory result. Symptoms were minor and easy to be controlled by antibiotic therapy. The disease severity score （DSS） was 1 in 5 patients and 0 in one patient. All of them recovered to the score of 0 within 3 ＇days after antibiotic therapy. Peritonitis relapsing after withdrawal of antibiotic therapy with the average interval between the 2 episodes of 2.4 weeks （4 days to 4 weeks）. Change the catheter with a new one was performed in 5 cases, and insertion of a new catheter after removal of the catheter for 2 weeks was conducted in one case. These cases had no relapsing peritonitis any more for more than 8 months after catheter exchange. Conclusions Catheter exchange combined with optimal antibiotic therapy is an effective way to eradicate relapsing peritonitis in PD patients.