Clinical Characteristics of Culture-Positive Exit-Site Infections in Peritoneal Dialysis Patients

腹膜透析病人導管出口感染之臨床特徵

郭健群(Chien-Chun Kuo) ； 廖上智(Shang-Chih Liao) ； 陳靖博(Jin-Bor Chen)

《Acta Nephrologica》 24卷3期 (2010/07) Pp. 151-156

摘要

背景：導管出口感染在腹膜透析病人足相當常見的問題，但過去探討其臨床特徵病程預後之研究卻不多；本研究的內容為回顧並探討本院腹膜透析病人導管出口感染之臨床特徵號研究影響其預後之因素。
方法：本篇為一回溯觀察性質研究共收集了過去十二年來共115位於本院接受腹膜透析且罹患病菌培養陽性之導管出口威染病人去探討其臨床特徵並研究影響其預後之因素。
結果：115位腹膜透析病人十二年來共發生212次病菌培養陽性之導管出口感染事件，而且較集中發生於接受腹膜透析前三年。淋浴及不適當拉扯腹膜導管被認為是引起導管出口感染之主要原因。平均使用抗生素治療期間為159天；有132次(623%)感染僅使用一種抗生素，80次(37.7%)感染需使用兩種或以上之抗生素。格蘭氏陽性菌是主要引起感染之致病菌(79.8%)，格蘭氏陰性菌次之；金黃色葡萄球菌為格蘭氏陽性菌中之最常見菌種；綠膿桿菌為格蘭氏陰性菌中之最常見菌種。共有50位病人發生重複感染，其中有5位因抗生素治療失敗(4/5)或腹膜炎(1/5)需要拔除腹膜導管。
結論：大部分導管出口感染發生於接受腹膜透析前幾年，而金黃色葡萄球菌為最常見引發導管出口感染之菌種。大部分導管出口感染均能以抗生素成功治療僅少數病人需要拔除腹膜導管，重複性一再感染可能是發生導管必須移除之危險因子。

關鍵字

導管出口感染 ； 腹膜透析 ； 導管移除

並列摘要

Background: The course of exit-site infections (ESI) is variable in peritoneal dialysis (PD) patients. There have been only a few investigations regarding the clinical characteristics of ESI. This study aims to review the clinical characteristics of ESI among PD patients and to identify the prognostic factors.
Methods: We retrospectively reviewed our PD patients from January 1995 to June 2008 to describe and investigate the clinical courses, presumed causes, antimicrobial agents, organisms involved, and outcomes of ESI episodes.
Results: A total 212 ESI episodes were identified. The majority of patients (57%) had one episode of ESI. ESI developed most frequently in the first 3 years after the initiation of PD. Showering and improper traction of the PD catheter were the most common presumed causes of ESI. The mean duration of antibiotic treatment was 15.9 days (range: 4-127 days). For treatment, 132 ESI episodes (62.3%) required only one type of antibiotics, while 80 other ESI episodes needed more than one type of antibiotics. Gram-positive organisms caused 193 episodes (80.4%): and gram-negative ones. 45 episodes (18.8%). Staphylococcus aureus was the most common pathogen among grain-positive organisms, while Pseudomonas aeruginosa was the most common among gram-negative organisms. Recurrent ESI occurred in 50 patients with 97 ESI episodes. Antibiotic therapy cured completely 197 episodes. Among these, 6 episodes received combined antibiotic therapy and externalized outer cuff management. In 5 patients with, recurrent ESI episodes required removal of PD catheter. The reasons for PD catheter removal included failed ESI treatment (4/5) and peritonitis (1/5). Conclusions: Most ESI episodes in chronic PD patients developed in the early years after the initiation of PD. S. aureus was the most common pathogen. Most ESI episodes reached a complete resolution, and episodes leading to catheter removal were rare. Recurrent ESI was a precipitating fact or for catheter removal.

並列關鍵字

Exit-site infection ； perituneal dialysis ； catheter removal