| Abstract | Unatoč brojnim prednostima koje nudi PD, postotak bolesnika u završnoj fazi bubrežne bolesti koji koristi ovu metodu opada, prvenstveno zbog najozbiljnije komplikacije ovog oblika terapije, a to je peritonitis. Cilj je ovog rada bilo prikazati demografske osobine pacijenata s peritonitisom povezanim s PD, rizične čimbenike za razvoj bolesti, terapiju i ishod. Ovo retrospektivno istraživanje provedeno je na Zavodu za nefrologiju i dijalizu u KBC-u Sestre milosrdnice u Zagrebu. Istraživanjem je bilo obuhvaćeno 78 pacijenata na PD u razdoblju od 1. siječnja 2001. godine do 31. prosinca 2013. godine, a podaci su prikupljeni iz povijesti bolesti svih pacijenata na PD iz toga perioda. Od toga broja 60,26% (n=47) pacijenata je imalo peritonitis, a ukupan broj epizoda peritonitisa je bio 94. Udio muškaraca u odnosu na žene bio je 57,45% (n=27) prema 42,55% (n=20). Najčešći je razlog bubrežnog zatajenja bila dijabetička nefropatija (n=15; 31,91%). Od komorbiditeta, najučestalija je bila hipertenzija (n=36; 76,60%). Incidencija peritonitisa iznosila je prosječno 0,41 epizodu/pacijent-godina za cijeli period praćenja. Najviše je pacijenata (n=23; 48,94%) imalo samo 1 epizodu peritonitisa. Od ukupnog broja epizoda, 41,49% (n=39) je bilo prouzročeno G+ mikroorganizmima, 21,28% (n=20) G- mikroorganizmima. Gljive su bile izolirane u 3,19% (n=3) epizoda, a u 6,38% (n=6) epizoda bilo je izolirano više mikroorganizama. U 18,09% (n=17) epizoda, kultura dijalizata je ostala sterilna, a za 9,57% (n=9) nije bilo podataka o izoliranim uzročnicima. Ukupno je izolirano 80 uzročnika, a od toga su većinu činili KNS (n=32; 40,00%) i Escherichia coli (n=10: 12,50%). Prema podrijetlu organizama, koža je bila izvor uzročnika infekcije u 58,82% (n=40) slučajeva, a uzročnici su bili fekalnog podrijetla u 30,88% (n=21) slučajeva. Koristeći samo medikamentnu terapiju izliječeno je ukupno 68,09% (n=64) epizoda peritonitisa, dok je smrtni je ishod nastupio u 8,51% (n=8) epizoda. Peritonitis kao neposredan uzrok smrti navodi se u 37,5% (n=3) slučajeva, a kao ostali razlozi navedeni su sepsa (n=2; 25,00%), kardiopulmonalni arest (n=1; 12,5%) te atrioventrikularna fibrilacija (n=1; 12,5%). Prikazana su i 3 slučaja pacijenata sa sklerozirajućim peritonitisom. Većina je pacijenata u terapiji primila cefazolin, cefuroksim ili ceftazidim kao monoterapiju ili u kombinaciji s drugim antimikrobnim lijekovima u sklopu empirijske terapije. Drugi je režim antibiotika korišten u 26,59% (n=25) epizoda peritonitisa pri čemu je najčešće upotrebljavan vankomicin. U ovom je istraživanju nađeno i da niti spol niti diabetes mellitus u pacijenata na PD nisu statistički značajno povezani s većim rizikom od razvoja peritonitisa ili većeg broja epizoda peritonitisa. Iako se incidencija peritonitisa postupno smanjuje, potrebno je još veće unaprjeđenje preventivnih mjera, a osobitu pažnju treba posvetiti edukaciji pacijenata o pravilnom provođenju PD te održavanju higijene. |
| Abstract (english) | Despite the numerous advantages offered by the PD, the percentage of patients in the end stage renal disease using this method decreases, mainly because of the most serious complication of this form of therapy, which is peritonitis. The aim of this study was to show the demographic characteristics of patients with PD associated peritonitis, risk factors for developing the disease, treatment and outcome. This retrospective study was conducted at the Department of nephrology and dialysis at Clinical Hospital Center Sestre milosrdnice in Zagreb. The study included 78 patients on PD in the period from January 1, 2001 to December 31, 2013, and the data were obtained from the medical histories of all patients on PD from that period. Out of the total number of patients, 60.26% (n=47) of patients had peritonitis, and the total number of peritonitis episodes was 94. The share of men compared to the share of women was 57.45% (n=27) to 42.55% (n=20). The most common cause of renal failure was diabetic nephropathy (n=15, 31.91%). The most common comorbidity was hypertension (n=36, 76.60%). The average incidence of peritonitis was 0.41 episodes/patient-year for the entire follow-up period. Most of the patients (n=23, 48.94%) had only one episode of peritonitis. Out of the total number of episodes, 41.49% (n=39) were caused by G+ microorganisms, 21.28% (n=20) by G-organisms. Fungi were isolated in 3.19% (n=3) of episodes, and in 6.38% (n=6) of episodes multiple microorganisms were isolated. In 18.09% (n=17) of episodes, the dialysate culture was sterile, and the data were not obtained in 9.57% (n=9) of episodes. Altogether 80 agents were isolated, of which the majority were CoNS (n=32, 40.00%) and Escherichia coli (n=10: 12.50%). According to the origin of organisms, the skin is a source of zoonotic infection in 58.82% (n=40) of cases, whilst the organisms were of fecal origin in 30.88% (n=21) of cases. A total of 68.09% (n=64) of peritonitis episodes were cured only using the drugs in the therapy, while the death occurred in 8.51% (n=8) of episodes. Peritonitis as the immediate cause of death was stated in 37.5% (n=3) cases, and the other cited reasons were sepsis (n=2; 25.00%), cardiopulmonary arrest (n=1, 12.5%) and atrioventricular fibrillation (n=1, 12.5%). The three patients with sclerosing peritonitis were described. Most of the patients were treated with cefazolin, cefuroxime or ceftazidime as monotherapy or in combination with other antimicrobial drugs within the empirical therapy. The second regime of antibiotics was used in 26.59% (n=25) of peritonitis episodes and vancomycin was mostly administrated. In this study it was found that neither gender nor diabetes mellitus in patients on PD are associated with a statistically higher risk of developing peritonitis or a larger number peritonitis episodes. Despite the fact that the incidence of peritonitis is gradually decreasing, preventive measures still need to be improved, and particular attention should be devoted to educating patients on the proper implementation of PD and hygiene. |
