Læknablaðið - 15.01.1996, Blaðsíða 71

LÆKNABLAÐIÐ 1996; 82
53
Lífhimnubólgur tengdar kviðskilun
Ólafur S. lndriöason1), Karl G. Kristinsson2), Páll Ásmundsson11, Magnús Böðvarsson11
Pcritonitis associatcd with peritoncai dialysis
Indriðason ÓS, Kristinsson KG, Ásmundsson P,
Böðvarsson M
Læknablaðið 1996; 82: 53-9
Continuous ambulatory peritoneal dialysis (CAPD)
is now a recognised treatment for end stage renal
disease. An estimated number of 27.000 patients
was being treated by CAPD world-wide in the year
1985. The most important complication is infection,
peritonitis. The CAPD program started in Iceland
in April 1985 at the dialysis department of the Na-
tional University Hospital. The aim of this study was
to estimate the incidence of infection associated
with peritoneal dialysis during the first five years.
All positive cultures of peritoneal dialysates from
the Department of Bacteriology, and the hospital
records of patients on CAPD, during the time peri-
od 12.04.1985 to 12.04.1990, were studied retrospec-
tively. CAPD was considered started as soon as the
peritoneal catheter had been inserted. Peritonitis
was considered to be present when the white blood
cell count was > 100/pl or there were clinical signs of
infection together with a positive culture from the
dialysate.
During the study period 27 patients were treated by
CAPD for 609.6 treatment months. Peritonitis was
diagnosed 83 times in 18 of these patients, giving an
incidence of 1.63/treatment year. The most common
cause was Stapliylococcus aureus, which was isolat-
ed 35 times (42%). Other causative organisms were:
17 coagulase negative staphylococci (21%), three
Gram negative rods (4%), one yeasts and three
mixed cultures. In 12 (14%) of the peritonitis epi-
sodes, no organisms were isolated. Admission to
hospital was considered necessary in 74% of the
episodes. One patient died of peritonitis.
Studies have demonstrated various infection rates
(0.23-6.3 infections/year), but has usually been be-
tween 0.8 and 1.2 infections/year. It is of interest to
Frá blóðskilunardeild", lyflaekningadeild" og sýklafræði-
deild21 Landspítalans. Fyrirspurnir, bréfaskipti: Karl G. Krist-
insson, sýklafræðideild Landspítalans, 101 Reykjavík.
Tölvupóstur: karl@rsp.is.
note that the most common causative organism in
this study was S. aureus, as opposed to coagulase
negative staphylococci, that have normally been the
most prevalent. S. aureus usually causes tunnel in-
fections, that are difficult to clear, without removing
the catheter. This study demonstrates an above av-
erage prevalence of infection, which should prompt
a reevaluation of the current management proto-
cols.
Correspondence: Karl G. Kristinsson. Department
of Clinical Microbiology, Landspítalinn, the Nation-
al University Hospital, 101 Reykjavík, Iceland.
E-mail: karl@rsp.is.
Ágrip
Sívirk kviðskilun (continuous ambulatory
peritoneal dialysis, CAPD) er nú viðurkennd
meðferð við nýrnabilun á lokastigi, en árið
1985 var áætlað að um 27.000 sjúklingar væru á
slíkri meðferð í heiminum. Helsti fylgikvilli er
sýking, það er lífhimnubólga (peritonitis).
Kviðskilun hófst á íslandi í apríl 1985 á blóð-
skilunardeild Landspítalans. Ákveðið var að
kanna tíðni lífhimnubólgu hjá þessum sjúkling-
um frá upphafi.
Gerð var afturvirk rannsókn sem náði yfir
tímabilið frá 12. apríl 1985 til 12. apríl 1990.
Farið var yfir allar ræktanir á kviðskilunar-
vökvum sem borist höfðu á sýklafræðideild
Landspítalans og sjúkraskrár allra sjúkling-
anna skoðaðar. Kviðskilun taldist hafin um
leið og kviðskilunarlegg hafði verið komið fyrir
inni í kviðarholinu. Lífhimnubólga taldist vera
til staðar ef í vökvanum voru yfir 100 hvít blóð-
korn/ul eða klínísk einkenni um sýkingu og
jákvæð ræktun.
Á þeim tíma sem rannsóknin náði til voru 27
sjúklingar meðhöndlaðir með kviðskilun í
609,6 meðhöndlunarmánuði. Lífhimnubólga
greindist í 83 tilfellum hjá 18 þessara sjúklinga,
og var sýkingartíðnin því 1,63 á meðhöndlunar-
ári. Algengasta orsök lífhimnubólgunnar var
Staphylococcus aureus, sem ræktaðist í 35 til-