Clinical Analysis of Chronic Peritoneal Dialysis Related Peritonitis in Children

孩童慢性腹膜透析相關腹膜炎之臨床分析

蔡亞秦(Ya-Chin Tsai) ； 蔡淳娟(Tsuen-Chiuan Tsai) ； 蔡政道(Jeng-Daw Tsai) ； 黃富源(Fu-Yuan Huang) ； 林淳貞(Chun-Chen Lin) ； 許錦城(Jin-Cherng Sheu)

《Acta Paediatrica Taiwanica》 47卷2期 (2006/04) Pp. 72-76

https://doi.org/10.7097/APT.200604.0072

摘要

在大部分的國家，腹膜透析對於孩童及青少年來說是較適當的透析方式。與腹膜透析相關之腹膜炎對於尿毒症的病人來說是一個很嚴重的併發症，甚至會影響病人的預後。然而，與孩童長期腹膜透析相關腹膜炎的報告卻有限。我們回溯22位在本院進行長期腹膜透析病人的資料：腹膜炎的總發生率是平均每23.7個月發生一次腹膜炎；腹膜炎的發生率在APD或是CAPD並無顯著差別。金黃色葡萄球菌是最常見的致病菌。合併使用vancomycin加上ceftazidime對腹膜炎常見的菌種是相當有效的。另外如果病人對起始的治療反應不佳必須考慮某些少見的菌種，例如黴菌或結核桿菌。及早診斷和治療腹膜炎對於預防後續的併發症及死亡率是相當重要的。

關鍵字

腹膜炎 ； 連續可攜帶式腹膜透析 ； 全自動腹膜透析 ； 金黃色葡萄球菌

並列摘要

In most countries, chronic peritoneal dialysis (PD) is the preferred dialysis mode for children and adolescents below the age of 15 years with end-stage renal disease. PD-related peritonitis is a serious complication that has a great impact on uremic patients' outcome. We retrospectively reviewed the charts of a total of 22 uremic children who underwent chronic peritoneal dialysis. The total peritonitis rate in our study was one episode every 23.7 patient-months, and there was no signicant difference in the incidence of peritonitis between children with automated peritoneal dialysis and those with continuous ambulatory peritoneal dialysis (p=0.219). Staphylococcus aureus was the most common causative organism, accounting for 13.3% of the episodes of peritonitis. The combination therapy of vancomycin plus ceftazidime is effective for common pathogens in peritonitis. Rare microorganisms, e. g., fungus and mycobacterium, should be taken into consideration when the response to initial treatment is poor. Early diagnosis and treatment is important to prevent sequelae and mortality.

並列關鍵字

peritonitis ； continuous ambulatory peritoneal dialysis ； automated peritoneal dialysis ； Staphylococcus aureus