腹膜透析患者感染性腹膜炎治療中抗生素給藥途徑的探討_West China Medical Journal

Authors：

 王晨 ,  費小凡 , 饒凡 , 蘇蘭 , 徐萍蓉

四川大學華西醫院藥劑科（成都 610041）;

Corresponding?author：

王晨, Email: 505484571@qq.com; 費小凡, Email: fxiaofan@yahoo.com.cn

Keywords：

腹膜透析; 感染性腹膜炎; 抗生素; 給藥途徑

DOI：

10.7507/1002-0179.20150513

Video：

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腹膜透析是腎病患者到尿毒癥或腎臟衰竭期所采用的一種有效的治療方法，但患者常常由于反復的并發癥不得不提早終止腹膜透析，甚至危及生命。感染性腹膜炎是腹膜透析治療中最常見的并發癥，目前國內外較多采用腹腔給藥的方式治療腹膜透析患者的感染性腹膜炎，但這種給藥途徑在對腹膜的刺激、對肝腎的損傷、藥物穩定性、藥物相互作用方面均存在多種風險。建議臨床使用抗生素治療腹膜透析患者的感染性腹膜炎時，考慮多方面的因素及風險，選擇最適合的給藥途徑。現結合目前國內外的治療方法及抗生素使用情況，探討腹膜透析患者感染性腹膜炎治療中抗生素的給藥途徑。

Citation： 王晨, 費小凡, 饒凡, 蘇蘭, 徐萍蓉. 腹膜透析患者感染性腹膜炎治療中抗生素給藥途徑的探討. West China Medical Journal, 2015, 30(9): 1793-1797. doi: 10.7507/1002-0179.20150513 Copy

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2.	Strippoli GF, Tong A, Johnson D, et al. Antimicrobial agents to prevent peritonitis in peritoneal dialysis:a systematic review of randomized controlled trials[J]. Am J Kidney Dis, 2004, 44(4):591-603.
3.	Peritoneal Dialysis Adequacy Work Group. Clinical practice guidelines for peritoneal dialysis adequacy[J]. Am J Kidney Dis, 2006, 48(Suppl 1):S98-S129.
4.	Piraino B, Bailie GR, Bernardini J, et al. Peritoneal dialysis-related infections recommendations:2005 update[J]. Perit Dial Int, 2005, 25(2):107-131.
5.	Caring for Australians with Renal Impairment (CARI). The CARI guidelines. Evidence for peritonitis treatment and prophylaxis:prophylactic antibiotics for insertion of peritoneal dialysis catheter[J]. Nephrology (Carlton), 2004, 9(Suppl 3):S72-S75.
6.	Strippoli GF, Tong A, Johnson D, et al. Catheter-related interventions to prevent peritonitis in peritoneal dialysis:a systematic review of randomized, controlled trials[J]. J Am Soc Nephrol, 2004, 15(10):2735-2746.
7.	黎偉, 廖蘊華, 薛超, 等. 腹膜透析相關性腹膜炎相關因素分析[J]. 廣東醫學, 2007, 28(8):1292-1294.
8.	Barbosa D, Lima L, Silbert S, et al. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis[J]. Am J Kidney Dis, 2004, 44(2):337-343.
9.	O'Riordan A, Abraham KA, Ho JK, et al. Vancomycin-resistant Peritonitis associated with peritoneal dialysis:a cause for concern[J]. Ir J Med Sci, 2002, 171(1):42-43.
10.	Passadakis P, Oreopoulos D. The case for oral treatment of peritonitis in continuous ambulatory peritoneal dialysis[J]. Adv Perit Dial, 2001, 17:180-190.
11.	Morse GD, Farolino DF, Apicella MA, et al. Comparative study of intraperitoneal and intravenous vancomycin pharmacokinetics during continuous ambulatory peritoneal dialysis[J]. Antimicrob Agents Chemother, 1987, 31(2):173-177.
12.	Tosukhowong T, Eiam-Ong S, Thamutok K, et al. Pharmacokinetics of intraperitoneal cefazolin and gentamicin in empiric therapy of peritonitis in continuous ambulatory peritoneal dialysis patients[J]. Perit Dial Int, 2002, 21(6):587-594.
13.	Bouza P, García Falcón T, Pérez Fontán M, et al. Treatment of CAPD-related peritonitis with ciprofloxacin:results after seven years[J]. Adv Perit Dial, 1996, 12:185-188.
14.	Pérez Fontán M, Rosales M, Rodríguez-Carmona A, et al. Treatment of peritonitis in CAPD with ciprofloxacin:long-term experience[J]. Adv Perit Dial, 1993, 9:211-214.
15.	Van Biesen W, Vanholder R, Vogelaers D, et al. The need for a center-tailored treatment protocol for peritonitis[J]. Perit Dial Int, 1998, 18(3):274-281.
16.	Nye KJ, Gibson SP, Nwosu AC, et al. Single-dose intraperitoneal vancomycin and oral ciprofloxacin for the treatment of peritonitis in CAPD patients:preliminary report[J]. Perit Dial Int, 1993, 13(1):59-60.
17.	Celik A, Cirit M, Tünger A, et al. Treatment of CAPD peritonitis with oral trimethoprim/sulfamethoxazole and intraperitoneal aminoglycoside combination[J]. Perit Dial Int, 1999, 19(3):284-285.
18.	Szeto CC, Chow KM, Kwan BC, et al. Staphylococcus aureus peritonitis complicates peritoneal dialysis:review of 245 consecutive cases[J]. Clin J Am Soc Nephrol, 2007, 2(2):245-251.
19.	郭群英, 陳林, 陽曉, 等. 腹膜透析相關感染性腹膜炎致病菌及菌譜變化——單個腹膜透析中心15年回顧分析[J]. 中華腎臟病雜志, 2006, 22(12):719-724.
20.	Krishnan M, Thodis E, Ikonomopoulos D, et al. Predictors of outcome following bacterial peritonitis in peritoneal dialysis[J]. Perit Dial Int, 2002, 22(5):573-581.
21.	呂鵬. 腹膜透析相關腹膜炎致病菌及耐藥性分析(附65例報告)[J]. 中國現代藥物應用, 2012, 1(6):82-83.
22.	吳晶晶, 劉佳, 張莉, 等. 腹膜透析相關性腹膜炎致病菌及耐藥性分析[J]. 中華醫院感染學雜志, 2011, 16(16):3521-3523.
23.	賀全仁, 陳孝治. 耐甲氧西林金葡球菌的藥物防治[J]. 國外醫藥:抗生素分冊, 1997, 18(6):442-443, 472.
24.	Krothapalli RK, Senekjian HO, Ayus JC. Efficacy of intravenous vancomycin in the treatment of gram-positive peritonitis in long-term peritoneal dialysis[J]. Am J Med, 1983, 75(2):345-348.
25.	程莉, 候凡凡, 張訓, 等. CAPD相關性腹膜硬化[J]. 國外醫學:泌尿系統分冊, 1996, 16(2):67-70.
26.	Barratt M, Davison AMA, Cameron JS, et al. Oxford textbook of clinical nephrology[M]. Oxford:Oxford University Press, 1992:1477-1505.
27.	Taipale J, Saharinen J, Hedman K, et al. Latent transforming growth factor-beta 1 and its binding protein are components of extracellular matrix microfibrils[J]. J Histochem Cytochem, 1996, 44(8):875-889.
28.	田文謀, 于德昌. 腹膜炎[M]. 北京:人民衛生出版社, 1988:8.
29.	Shemin D, Maaz D, St Pierre D, et al. Effect of aminoglycoside use on residual renal function in peritoneal dialysis patients[J]. Am J Kidney Dis, 1999, 34(1):14-20.
30.	白建偉, 晉援朝, 白林, 等. 氟康唑與四種抗生素的配伍和穩定性[J]. 第四軍醫大學學報, 2004, 25(12):1140-1142.
31.	牛鳳珍, 畢秀云. 可夫新與頭孢哌酮鈉舒巴坦鈉存在配伍禁忌[J]. 臨床護理雜志, 2009, 3(3):69.
32.	李健, 周燕文, 馬妮飛. 氟羅沙星注射液與4種抗生素配伍的穩定性[J]. 中國醫院藥學雜志, 2002, 1(1):61-62.
33.	毛文, 周少懷, 柯國平. 加替沙星注射液與4種抗生素配伍的穩定性[J]. 數理醫藥學雜志, 2007, 4(4):530-531.
34.	陳灝珠. 實用內科學[M]. 11版. 北京:人民衛生出版社, 2002:1789-1791.
35.	鄭芝田. 胃腸病學[M]. 3版. 北京:人民衛生出版社, 2000:839-843.

1. Abstracts:the American Society of Nephrology. Chicago, Illinois, December 12-14, 1982[J]. Kidney Int, 1983, 23(1):93-298.
2. Strippoli GF, Tong A, Johnson D, et al. Antimicrobial agents to prevent peritonitis in peritoneal dialysis:a systematic review of randomized controlled trials[J]. Am J Kidney Dis, 2004, 44(4):591-603.
3. Peritoneal Dialysis Adequacy Work Group. Clinical practice guidelines for peritoneal dialysis adequacy[J]. Am J Kidney Dis, 2006, 48(Suppl 1):S98-S129.
4. Piraino B, Bailie GR, Bernardini J, et al. Peritoneal dialysis-related infections recommendations:2005 update[J]. Perit Dial Int, 2005, 25(2):107-131.
5. Caring for Australians with Renal Impairment (CARI). The CARI guidelines. Evidence for peritonitis treatment and prophylaxis:prophylactic antibiotics for insertion of peritoneal dialysis catheter[J]. Nephrology (Carlton), 2004, 9(Suppl 3):S72-S75.
6. Strippoli GF, Tong A, Johnson D, et al. Catheter-related interventions to prevent peritonitis in peritoneal dialysis:a systematic review of randomized, controlled trials[J]. J Am Soc Nephrol, 2004, 15(10):2735-2746.
7. 黎偉, 廖蘊華, 薛超, 等. 腹膜透析相關性腹膜炎相關因素分析[J]. 廣東醫學, 2007, 28(8):1292-1294.
8. Barbosa D, Lima L, Silbert S, et al. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis[J]. Am J Kidney Dis, 2004, 44(2):337-343.
9. O'Riordan A, Abraham KA, Ho JK, et al. Vancomycin-resistant Peritonitis associated with peritoneal dialysis:a cause for concern[J]. Ir J Med Sci, 2002, 171(1):42-43.
10. Passadakis P, Oreopoulos D. The case for oral treatment of peritonitis in continuous ambulatory peritoneal dialysis[J]. Adv Perit Dial, 2001, 17:180-190.
11. Morse GD, Farolino DF, Apicella MA, et al. Comparative study of intraperitoneal and intravenous vancomycin pharmacokinetics during continuous ambulatory peritoneal dialysis[J]. Antimicrob Agents Chemother, 1987, 31(2):173-177.
12. Tosukhowong T, Eiam-Ong S, Thamutok K, et al. Pharmacokinetics of intraperitoneal cefazolin and gentamicin in empiric therapy of peritonitis in continuous ambulatory peritoneal dialysis patients[J]. Perit Dial Int, 2002, 21(6):587-594.
13. Bouza P, García Falcón T, Pérez Fontán M, et al. Treatment of CAPD-related peritonitis with ciprofloxacin:results after seven years[J]. Adv Perit Dial, 1996, 12:185-188.
14. Pérez Fontán M, Rosales M, Rodríguez-Carmona A, et al. Treatment of peritonitis in CAPD with ciprofloxacin:long-term experience[J]. Adv Perit Dial, 1993, 9:211-214.
15. Van Biesen W, Vanholder R, Vogelaers D, et al. The need for a center-tailored treatment protocol for peritonitis[J]. Perit Dial Int, 1998, 18(3):274-281.
16. Nye KJ, Gibson SP, Nwosu AC, et al. Single-dose intraperitoneal vancomycin and oral ciprofloxacin for the treatment of peritonitis in CAPD patients:preliminary report[J]. Perit Dial Int, 1993, 13(1):59-60.
17. Celik A, Cirit M, Tünger A, et al. Treatment of CAPD peritonitis with oral trimethoprim/sulfamethoxazole and intraperitoneal aminoglycoside combination[J]. Perit Dial Int, 1999, 19(3):284-285.
18. Szeto CC, Chow KM, Kwan BC, et al. Staphylococcus aureus peritonitis complicates peritoneal dialysis:review of 245 consecutive cases[J]. Clin J Am Soc Nephrol, 2007, 2(2):245-251.
19. 郭群英, 陳林, 陽曉, 等. 腹膜透析相關感染性腹膜炎致病菌及菌譜變化——單個腹膜透析中心15年回顧分析[J]. 中華腎臟病雜志, 2006, 22(12):719-724.
20. Krishnan M, Thodis E, Ikonomopoulos D, et al. Predictors of outcome following bacterial peritonitis in peritoneal dialysis[J]. Perit Dial Int, 2002, 22(5):573-581.
21. 呂鵬. 腹膜透析相關腹膜炎致病菌及耐藥性分析(附65例報告)[J]. 中國現代藥物應用, 2012, 1(6):82-83.
22. 吳晶晶, 劉佳, 張莉, 等. 腹膜透析相關性腹膜炎致病菌及耐藥性分析[J]. 中華醫院感染學雜志, 2011, 16(16):3521-3523.
23. 賀全仁, 陳孝治. 耐甲氧西林金葡球菌的藥物防治[J]. 國外醫藥:抗生素分冊, 1997, 18(6):442-443, 472.
24. Krothapalli RK, Senekjian HO, Ayus JC. Efficacy of intravenous vancomycin in the treatment of gram-positive peritonitis in long-term peritoneal dialysis[J]. Am J Med, 1983, 75(2):345-348.
25. 程莉, 候凡凡, 張訓, 等. CAPD相關性腹膜硬化[J]. 國外醫學:泌尿系統分冊, 1996, 16(2):67-70.
26. Barratt M, Davison AMA, Cameron JS, et al. Oxford textbook of clinical nephrology[M]. Oxford:Oxford University Press, 1992:1477-1505.
27. Taipale J, Saharinen J, Hedman K, et al. Latent transforming growth factor-beta 1 and its binding protein are components of extracellular matrix microfibrils[J]. J Histochem Cytochem, 1996, 44(8):875-889.
28. 田文謀, 于德昌. 腹膜炎[M]. 北京:人民衛生出版社, 1988:8.
29. Shemin D, Maaz D, St Pierre D, et al. Effect of aminoglycoside use on residual renal function in peritoneal dialysis patients[J]. Am J Kidney Dis, 1999, 34(1):14-20.
30. 白建偉, 晉援朝, 白林, 等. 氟康唑與四種抗生素的配伍和穩定性[J]. 第四軍醫大學學報, 2004, 25(12):1140-1142.
31. 牛鳳珍, 畢秀云. 可夫新與頭孢哌酮鈉舒巴坦鈉存在配伍禁忌[J]. 臨床護理雜志, 2009, 3(3):69.
32. 李健, 周燕文, 馬妮飛. 氟羅沙星注射液與4種抗生素配伍的穩定性[J]. 中國醫院藥學雜志, 2002, 1(1):61-62.
33. 毛文, 周少懷, 柯國平. 加替沙星注射液與4種抗生素配伍的穩定性[J]. 數理醫藥學雜志, 2007, 4(4):530-531.
34. 陳灝珠. 實用內科學[M]. 11版. 北京:人民衛生出版社, 2002:1789-1791.
35. 鄭芝田. 胃腸病學[M]. 3版. 北京:人民衛生出版社, 2000:839-843.

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腹膜透析患者感染性腹膜炎治療中抗生素給藥途徑的探討

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