CAPD 환자에서 재발성 복막염의 임상적 특성

Abstract

Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheterrelated infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were' 1) to analyze the causative pathogen', 2) to determine the appropriate treatment regimen and duration', and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culturepositive. The distribution of isolates was as follows ' coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphyloco- ccus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46(50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Grampositive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy witb vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gramnegative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylo- coccal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Grampositive and Gram-negative perito- nitis, there was no reduction of recurrence in peri- tonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.