Pseudomonal Peritonitis in CAPD Patients

連續可活動性腹膜透析病人發生綠膿桿菌腹膜炎的臨床經驗

藍文君(Wen-Chun Lan) ； 陳鴻鈞(Hung-Chun Chen) ； 黃尚志(Shang-Jyh Hwang) ； 郭弘典(Hung-Tien Kuo) ； 蔡秋月(Chiu-Yueh Tsai) ； 賴永勳(Yung-Hsiung Lai)

《Acta Nephrologica》 14卷4期 (2000/10) Pp. 320-320

並列摘要

Background Peritonitis remains the leading cause of hospitalization, technique failure and catheter loss in CAPD to hemodialysis and even higher mortality rate. Recent reports demonstrated that the incidence of gram-positive peritonitis decrease significantly, however, gram-negative peritonitis remains constant.
Material and methods From February 1984 to December 2000, all 161 episodes of peritonitis in CAPD patients enrolled at KMUH were reviewed. Amount them, a total of 29 episodes induced by PSA were collected. We compared the change of body weight, blood pressure, WBC count, and biochemical data between 3 months before the peritonitis and when the peritonitis onset. The prognosis and cause of death were also studied.
Results Our overall peritonitis rate dropped from the highest 0.75 episodes/patientet-year in 1986 to the lowest 0.13 episodes/patienet-year in 2000. The PSA peritonitis decreased significantly from the highest 0.25 episodes/patient-year in 1986 to the lowest 0.017 episodes/patient-year in 1996, and none of 80 CAPD patients in 2000 had peritonitis with PSA. There were lower serum albumin level (p＜0.001) and higher WBC count (p-0.0002)when Pseudomonal peritonitis attack, but no significant difference in body weight, blood pressure, hemoglobin, and lipid profile were found. Five patients had reinfections and 2 cases secondary to acute appendicitis. Totally 11 episodes (37.9%) resolved without catheter removal. The catheter removal rate was 62.1%, with most of catheters removed at the 10th to 11th days after onset of peritonitis. DM and male patients had higher mortality; only 3 patients were directly died of sepsis caused by PSA peritonitis. After follow up for 64.1±49.8 months, 10 of 23 patients were transferred to HD, 5 patients (21.75) were still on CAPD and 2patients were successfully treated with renal transplantation.
Conclusion We have found a decreased incidence of PSA peritonitis in recent years, which can be treated successfully in 37.9% episodes without catheter removal.