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首页> 外文期刊>Peritoneal dialysis international: Journal of the International Society for Peritoneal Dialysis >Culture-negative peritonitis associated with the use of icodextrin-containing dialysate in twelve patients treated with peritoneal dialysis.
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Culture-negative peritonitis associated with the use of icodextrin-containing dialysate in twelve patients treated with peritoneal dialysis.

机译：在使用腹膜透析治疗的十二名患者中，培养阴性的腹膜炎与含艾考糊精的透析液的使用有关。

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BACKGROUND: In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. DESIGN: Case studies in 12 patients. SETTING: Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). PATIENTS: 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. RESULTS: At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100-1,500 cells/mm3). Differentiation of the dialysate leukocytesshowed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. CONCLUSION: Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.
机译：背景：在2001年上半年，中心A发生了异常多的培养阴性腹膜炎发作。一名患者注意到，他的培养阴性的抗生素耐药性腹膜炎在无意中停止使用含艾考糊精的透析液后迅速清除。 ，但再次使用艾考糊精后立即复发。该观察结果导致在A中心识别了8例同期艾考糊精诱导的培养阴性腹膜炎病例，并在B中心识别了3例其他病例。设计：12例病例研究。地点：大学医院和附属单位的腹膜透析科（中心A），以及第二所大学医院（中心B）。患者：12例腹膜透析患者出现培养阴性的腹膜炎。结果：就诊时，腹痛不存在或轻度，透析液白细胞计数适度升高（约100-1,500个细胞/ mm3）。透析液白细胞的分化显示中性粒细胞的比例低（约35％）。在八例中，有证据表明腹膜炎是由艾考糊精引起的（上述临床表现和实验室结果，对抗生素治疗无反应，艾考糊精停药后治愈，再挑战后复发）;在3例患者中，证据确凿（与上述案例相同，但未进行任何挑战）。停止艾考糊精可立即缓解症状，并使透析液白细胞计数正常化。再挑战后，通常会在几天内复发。在一个案例中，证据是间接的。结论：我们的发现与艾考糊精诱导的腹膜炎相吻合。该实体的特征是出现时出现轻度的腹痛，中度透析液白细胞增多，中性粒细胞分数低，以及对抗生素治疗的抵抗力。关于这种类型的腹膜炎的发病机理的推测包括由于污染物质或对艾考糊精过敏的化学性腹膜炎。

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