维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

Clinical reports for peritoneal dialysis-related peritonitis

Objective To investigate causes and risk factors of peritoneal dialysis-related peritonitis, explore the pathogenic bacteria and drug sensitivity. Methods CAPD patients suffered peritoneal dialysis-related peritonitis were recruited in the First Affiliated Hospital of Nanjing Medical University in 2012. Gender, age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis. The causes, pathogenic bacteria, drug susceptibility, and validity treated with cefazolin plus ceftazidime were also analyzed. Results Thirty patients suffered peritoneal dialysis-related peritonitis and 129 peritoneal dialysis patients without peritonitis as control were included. The main causes for peritoneal dialysis-related peritonitis were nonstandard operating steps and intestinal infection. Multivariate logistic regression analysis showed that peritoneal dialysis-related peritonitis was significantly associated with higher CRP level. Of the peritoneal fluid culture, 26 cases were found positive and the positive rate was 76.47%, 19 cases (73.08％) were infected with Gram-positive cocci, 6 cases (23.08％) with Gram-negative bacillus and 1 case (3.85％) with fungi. Drug sensitivity test showed that Gram-positive cocci had the resistance rate to cefazolin(16.67％), and was sensitive to vancomycin in all cases. Gram-negative bacilli had the resistance to ceftazidime (20.00％), and was sensitive to imipenem and meropenem in all cases. All patients were given cefazolin plus ceftazidime as initial treatment. Twenty-seven cases were effective and the primary efficiency were 79.41％. Conclusions The main causes of peritoneal dialysis-related peritonitis in our centre were nonstandard operating steps and intestinal infection. The higher CRP level is an independent risk factor of peritoneal dialysis-related peritonitis. Gram-positive cocci are the main pathogenic bacteria leading to peritoneal dialysis-related peritonitis. There is lower resistance rate in Gram-positive cocci to cefazolin and Gram-negative bacilli to ceftazidime. Cefazolin plus ceftazidime can be an effective medicine on initiinal treatment of peritoneal dialysis-related peritonitis.     

腹膜透析相关性腹膜炎经验用药分析

目的 研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归,为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性,阳性率为80.2％,其中革兰阳性球菌45例,革兰阴性杆菌21例,真菌2例,革兰阳性杆菌1例,革兰阴性球菌1例,多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有革兰阳性球菌对万古霉素均敏感,但对头孢唑林耐药率高达60.0%,而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1％,所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例,退出率为17.2％（16/93）。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高,目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

中医药防治腹膜透析相关性腹膜纤维化研究进展

腹膜透析患者由于长期使用葡萄糖透析液、腹膜炎等因素,可导致腹膜纤维化的发生,限制了该治疗方式在临床的使用。中医药防治腹膜纤维化具有广阔的应用前景,在实验及临床研究方面都取得了一定的成果。本文对近来中医药在防治腹膜透析相关性腹膜纤维化的研究进行综述,以期为更好的开展中医药防治腹膜透析相关性腹膜纤维化提供参考。     

Aspergillus fumigatus peritonitis in ambulatory peritoneal dialysis: a case report and notes on the therapeutic approach

Aspergillus peritonitis is a rare disease in continuous peritoneal dialysis. It is a severe form of peritonitis, which is frequently lethal. We report a case of Aspergillus fumigatus peritonitis in a female patient on automated peritoneal dialysis (APD), who was successfully treated with intravenous amphotericin B and the removal of the peritoneal catheter. As delayed treatment has an increased mortality rate, it is mandatory to remove the catheter and to start intravenous treatment with amphotericin B empirically.     

营养不良和慢性炎症对肠炎相关性腹膜炎腹透患者的影响

目的：探讨慢性炎症状态和营养状况对肠道感染相关性腹膜炎的腹膜透析患者的影响。方法：对我院腹膜透析中心2000年～2010年间收治的持续性不卧床腹膜透析并发腹膜炎的患者进行回顾性研究。将肠道感染相关性腹膜炎的患者（1组）,其他原因导致的腹膜炎的患者（2组）作为对照,比较两组临床和实验室数据,分析肠道感染相关性腹膜炎与免疫功能、营养状况等的关系。结果：1组12例,发生感染性腹膜炎23例次,2组31例,发生感染性腹膜炎53例次。与2组相比,1组患者血压和水肿情况明显升高,CRP明显增加,血红蛋白和血浆白蛋白明显降低,SGA评分营养不良的发生率较高（以上所有数据P〈0.05）。结论：与其他原因导致腹膜炎的患者相比,肠道感染相关性腹膜炎的患者的营养不良、慢性炎症和容量负荷较重。加强营养,积极治疗肠炎可能有助于该病的预防和控制。     

Aspergillus peritonitis in peritoneal dialysis: case report and a review of the literature

Aspergillus peritonitis is a rare complication of continuousambulatory peritoneal dialysis. The case is described of a 68-year-oldman in whom Aspergillus fumigatus was isolated from the peritonealdialysate after recurrent peritonitis with Gram-negative rodsin association with diverticulosis. Treatment consisting ofremoval of the catheter and intravenous administration of amphotericinB followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertaintiesregarding diagnostic awareness, culture diagnosis, and therapeuticmanagement. Next to institution of appropriate antifungal therapy,early removal the peritoneal dialysis catheter is recommended,as delayed removal of the catheter appears to be associatedwith increased mortality and morbidity.     

Beta 2-microglobulin amyloidosis in a patient treated exclusively by continuous ambulatory peritoneal dialysis

The histological demonstration of beta 2-microglobulin (B2M) amyloidosis in a 75-year-old man treated exclusively by continuous ambulatory peritoneal dialysis (CAPD) for 87 months is reported. Amyloid deposits were detected in all joints from which synovial specimens were obtained at autopsy. It is of note that the patient had never undergone hemodialysis and had suffered only one episode of peritonitis. Both features are of interest, as the few reports of dialysis-related amyloidosis (DRA) in CAPD include patients who have been hemodialyzed and have suffered repeated episodes of peritonitis, both conditions being incriminated in the genesis of B2M amyloidosis. We conclude that DRA may develop in the absence of artificial membranes or frequent peritonitis episodes.     

Aspergillus peritonitis in continuous ambulatory peritoneal dialysis patients

Aspergillus peritonitis is a rare and serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 3 cases of aspergillus peritonitis in CAPD which were successfully treated by catheter removal and amphotericin. Two of the 3 patients returned temporarily to CAPD, but were subsequently transferred to hemodialysis because of membrane failure. A novel finding in 2 of the 3 cases was a positive Limulus amebocyte lysate test, despite negative bacterial cultures. We discuss the possible relevance of this finding to the diagnosis of aspergillus infections and emphasize the importance of early catheter removal for successful treatment of this condition.     

Successful treatment of Aspergillus peritonitis in an adult on continuous ambulatory peritoneal dialysis

This report describes the first successful treatment of an adult on continuous ambulatory peritoneal dialysis with Aspergillus peritonitis. The published literature is also reviewed. Early removal of the peritoneal catheter combined with antifungal chemotherapy appear to be necessary for cure in patients with this disease.     

ku Pasteurella multocida peritonitis in patients undergoing peritoneal dialysis

A 12-year-old girl on peritoneal dialysis developed sub-clinical peritonitis due to Pasteurella multocida, following puncture of her dialysis tubing by a domestic cat. Only four other similar cases of P. multocida peritonitis have been reported in adults. This unusual form of peritonitis could be easily prevented by not allowing domestic animals to come into contact with dialysis tubings in patients undergoing peritoneal dialysis. Received June 10, 1996; received in revised form and accepted October 1, 1996     

腹膜透析超滤衰竭的诊治策略

超滤衰竭是腹膜透析常见的并发症,是导致腹膜透析失败的重要原因之一。超滤衰竭定义为4.25%葡萄糖透析液留腹4 h后超滤量<400 ml。超滤衰竭根据病理生理机制分为4种类型：Ⅰ型超滤衰竭由于有效腹膜表面积增加导致,Ⅱ型超滤衰竭由于葡萄糖渗透转导作用下降导致,Ⅲ型超滤衰竭由于腹膜有效表面积减少导致,Ⅳ型超滤衰竭由于通过腹腔淋巴系统或局部组织间隙吸收大量水分导致。避免过度使用高浓度葡萄糖透析液、有效防治腹膜透析相关腹膜炎、保护残肾功能、选用生物相容性好的透析液、使用改善腹膜损伤和纤维化药物等是防治超滤衰竭的有益方法。     

Sclerosing encapsulating peritonitis: report of a case with small bowel obstruction managed by long-term home parenteral hyperalimentation, and a review of the literature

Sclerosing peritonitis has recently emerged as a complication of peritoneal dialysis associated with a high morbidity and mortality. These patients experience the characteristic syndrome of nausea, vomiting, abdominal pain, partial small bowel obstruction, and impaired ultrafiltration. A pathologic finding is the replacement of mesothelial cells with a thick layer of nondistensible fibroconnective tissue. We report here a 58-year-old white woman who developed peritoneal sclerosis after 4 years of peritoneal dialysis, including 3 years of continuous ambulatory peritoneal dialysis. Risk factors included peritoneal exposure to low concentrations of formaldehyde and a 1-week exposure to long-dwell acetate dialysate. Laparotomy for partial small bowel obstruction with resection of the involved segment was complicated by enterocutaneous fistulae, which improved only on cessation of oral intake and treatment with home parenteral nutrition. We have reviewed the literature to find 20 cases of sclerosing peritonitis in patients on peritoneal dialysis. A 78% mortality rate is reported in cases that had surgical intervention. We conclude that the use of long-term parenteral nutrition with cessation of oral intake may be necessary in the management of sclerosing encapsulating peritonitis.     

Tuberculous peritonitis in a CAPD patient cured without catheter removal: case report, review of the literature, and guidelines for treatment and diagnosis

Tuberculous peritonitis in the chronic peritoneal dialysis patient carries a high mortality, which may reflect the diagnostic delay that is often encountered in these cases. Accordingly, a high index of suspicion and an aggressive diagnostic approach (which may include laparoscopic biopsy) should be applied to the patient with persistent culture negative peritonitis. One of the first continuous ambulatory peritoneal dialysis (CAPD) cases involving tuberculous peritonitis successfully treated without interruption of dialysis or removal of the peritoneal dialysis catheter is reported. The literature is reviewed to provide diagnostic and therapeutic guidelines in dealing with this serious infection.     

Successful treatment of Aspergillus peritonitis in a peritoneal dialysis patient

Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). We report the successful treatment of refractory fungal peritonitis in an 8-year-old girl treated by peritoneal dialysis for 3.3 years. This is the second report of Aspergillus thermomutatus (telemorph: Neosartorya pseudofischeri) in humans. Comprehensive treatment included early removal of the CAPD catheter, the use of liposomal amphotericin B, and the use of itraconazole. Received: 21 August 2001 / Revised: 17 December 2001 / Accepted: 18 December 2001     

Peritoneal catheter colonization by Penicillium sp : Case report and review of penicillium-related complications in peritoneal dialysis

Fungal peritonitis is an uncommon, serious complication of peritoneal dialysis, usually caused by Candida sp . Asymptomatic fungal colonization of the peritoneal catheter is less frequent. Penicillium sp have only rarely been reported as a cause of peritoneal complications in peritoneal dialysis. We report a case of fever and peritoneal catheter malfunction associated with catheter colonization by Penicillium sp , in the absence of signs or symptoms of acute peritonitis. Cultures of the dialysate grew Penicillium sp, and histological examination showed penetration of the catheter by hyphae. The peritoneal catheter was removed, and the patient was maintained on hemodialysis and oral itraconazole for 6 weeks before successfully returning to continuous cycling peritoneal dialysis (CCPD). One case of Penicillium catheter colonization and seven of Penicillium peritonitis in peritoneal dialysis patients have been previously published in the English literature. Detailed data were provided in five reports. Delayed diagnosis was frequent (mean ± SD 31 ± 24 days after the onset of symptoms). Peritonitis cases were treated with catheter removal and antifungal medications, and the outcome was always satisfactory. We conclude that Penicillium should be considered a pathogenic fungus, not a contaminant, when isolated from peritoneal dialysis specimens, and should be treated accordingly. However, Penicillium may colonize the peritoneal catheter in the absence of peritonitis, and the prognosis of Penicillium peritonitis is good despite a frequent delay in diagnosis.     

Proteomic Analysis of Peritoneal Dialysate Fluid in Patients with Dialysis-Related Peritonitis

The prognosis of uremia patients on continuous ambulatory peritoneal dialysis (CAPD) is related to frequent peritonitis rate. Frequent peritonitis will lead to peritoneum failure, making CAPD unfeasible. We have performed proteomic profiling of peritoneal dialysis effluent samples from a cross-section of CAPD patients with and without peritonitis in order to identify biomarkers of peritonitis. We performed 2D gel electrophoresis and surface-enhanced laser esorption/ionization time of flight mass spectrometry (SELDI-TOF MS) on peritoneal dialysis effluent from 16 subjects with peritonitis. A genetic algorithm search of principal component space revealed a group of a peak distinguishing peritonitis-positive subjects, with mass/charge (m/z) values of 11,117.4. Our analyses identified the peak at m/z 11,117.4 with an accuracy of 95% for classifying peritonitis. Mass spectrometric analysis of peritonitis PDE samples identified the 11,117.4 protein as β2-microglobulin (B2M). Using an unbiased protein profiling approach, we have validated previously reported findings of B2M as a biomarker associated with CAPD peritonitis. Prospective studies are warranted to establish additional biomarkers that would be predictive of peritoneal dialysis peritonitis. Besides, extending the study to a larger number of patients with subgroup analyses may yield additional information of the peritoneal dialysate proteins in association with dialysis adequacy, residual renal function, nutritional status, and risk of peritoneal infection.     

Proteomic analysis of peritoneal dialysate fluid in patients with dialysis-related peritonitis

The prognosis of uremia patients on continuous ambulatory peritoneal dialysis (CAPD) is related to frequent peritonitis rate. Frequent peritonitis will lead to peritoneum failure, making CAPD unfeasible. We have performed proteomic profiling of peritoneal dialysis effluent samples from a cross-section of CAPD patients with and without peritonitis in order to identify biomarkers of peritonitis. We performed 2D gel electrophoresis and surface-enhanced laser esorption/ionization time of flight mass spectrometry (SELDI-TOF MS) on peritoneal dialysis effluent from 16 subjects with peritonitis. A genetic algorithm search of principal component space revealed a group of a peak distinguishing peritonitis-positive subjects, with mass/charge (m/z) values of 11,117.4. Our analyses identified the peak at m/z 11,117.4 with an accuracy of 95% for classifying peritonitis. Mass spectrometric analysis of peritonitis PDE samples identified the 11,117.4 protein as beta2-microglobulin (B2M). Using an unbiased protein profiling approach, we have validated previously reported findings of B2M as a biomarker associated with CAPD peritonitis. Prospective studies are warranted to establish additional biomarkers that would be predictive of peritoneal dialysis peritonitis. Besides, extending the study to a larger number of patients with subgroup analyses may yield additional information of the peritoneal dialysate proteins in association with dialysis adequacy, residual renal function, nutritional status, and risk of peritoneal infection.