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首页> 外文期刊>Peritoneal dialysis international: Journal of the International Society for Peritoneal Dialysis >Increased severity of Escherichia coli peritonitis in peritoneal dialysis patients independent of changes in in vitro antimicrobial susceptibility testing.
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Increased severity of Escherichia coli peritonitis in peritoneal dialysis patients independent of changes in in vitro antimicrobial susceptibility testing.

机译：腹膜透析患者中​​大肠杆菌腹膜炎的严重性增加，与体外抗菌药敏试验的变化无关。

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OBJECTIVE: Despite improvements in peritoneal dialysis (PD) technique, peritonitis continues to be one of the most frequent complications of PD. Nonresolving peritonitis remains a risk for severe anatomical peritoneal changes that may limit the viability of the membrane for dialysis purposes. We have observed remarkably poor outcome of peritonitis caused by Escherichia coli in the past 6 years. With its very low response rate to broad-spectrum antibiotics, the increased severity of E. coli peritonitis deteriorates peritoneal function and affects patient outcome. DESIGN: Retrospective study. SETTING: Two large PD units in two university hospitals. PATIENTS AND METHODS: The total number of patients reviewed was 456. The records of 49 E. coli peritonitis episodes were studied.The observation period started in 1980 and ended in March 2001. Sixteen males and 19 females were included. Severity was defined in terms of days of peritoneal inflammation, lack of response to a potentially useful antibiotic, requirement for catheter removal, and/or laparotomy. Study cases (study group) were those episodes appearing after 1996 (when the first severe cases appeared) and historic controls were episodes occurring before 1996. RESULTS: In the study group, 18 peritonitis episodes developed in 15 patients. In the control group, 31 peritonitis episodes developed in 20 patients. There were no significant differences in clinical presentation; however, the outcome was significantly poorer for the later period. A severe outcome occurred in 50% of study versus 10% of control patients. In fact, 68% of the episodes registered before 1996 were cured in 3 days or less. Concurring with this trend, the numbers of surgical interventions and catheter removals were also higher in the study group. Strikingly, E. coli did not show changes in in vitro susceptibility testing to antibiotics, although the in vivo response was much worse. CONCLUSIONS: We describe a change in the virulence of E. coli peritonitis episodes over the past 5 yearsleading to a high percentage of treatment failure, which does not depend on antibiotic sensitivity and seems to be dependent on changes in host response mechanisms.
机译：目的：尽管腹膜透析（PD）技术有所改进，但腹膜炎仍然是PD最常见的并发症之一。不能解决的腹膜炎仍然存在严重的腹膜解剖改变的风险，这可能会限制透析膜的活力。在过去的6年中，我们观察到由大肠杆菌引起的腹膜炎的预后很差。由于对广谱抗生素的应答率非常低，大肠杆菌腹膜炎的严重程度增加会恶化腹膜功能并影响患者预后。设计：回顾性研究。地点：两家大学医院中的两个大型PD设备。患者和方法：回顾性研究的患者总数为456名。研究了49例大肠杆菌腹膜炎发作的记录。观察期始于1980年，至2001年3月结束。其中包括16例男性和19例女性。严重程度根据腹膜炎症的天数，对可能有用的抗生素缺乏反应，需要拔除导管和/或剖腹术来定义。研究病例（研究组）是1996年之后（首例严重病例出现时）出现的发作，历史对照是1996年之前发生的发作。结果：研究组中，有15例发生了18例腹膜炎发作。在对照组中，有20例患者发生了31例腹膜炎发作。临床表现无明显差异。但是，结果在后期明显较差。 50％的研究发生了严重的预后，而对照组则为10％。实际上，在1996年之前记录的发作中有68％在3天内或更短时间内得到了治愈。与此趋势相吻合的是，研究组的外科手术和导管移除次数也更高。令人惊讶的是，尽管在体内的反应要差得多，但大肠杆菌在体外对抗生素的敏感性测试中并未显示出变化。结论：我们描述了过去5年中大肠杆菌腹膜炎发作的毒力变化，导致较高的治疗失败率，这不依赖于抗生素敏感性，而且似乎依赖于宿主反应机制的变化。

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