그람 음성균주에 의한 CAPD 복막염의 임상적 고찰

Abstract

We experienced 56 episodes of CAPD peritonitis caused by gram-negative organism, which accounted for 22.4% of all episodes of peritonits at Keimyung University Hospital from 1988 to 1992. Among the Gram-negative organisms. Pseudomonas species (23.2%) and Acinetobacter species (21.4%) were the two most frequent etiologies, followed by E. coli (17.8%), Enterobacter (12.5%) and Serratia (7.1%) species in decreasing order of frequency. Cramping abdominal pain was found in all cases, abdominal tenderness in 87%， rebound tenderness in 46.6%’ fever in 33.9%, nausea in 21.4% and vomiting in 7.8%, Peritoneal catheters had to be removed in 53.6% (30 of 56) of Gram-negative CAPD peritonitis. Among them, three patients were underwent laparotomy due to intra-abdominal abscess formation and peritoneal adhesion. It was necessary to remove the peritoneal catheter in all cases (100%) by Serratia species, in 69.2% by Pseudomonas species, in 50% by E. coli, Acinetobacter, Citrobacter and Pro-videncia. There were eight peritonitis-related death, and sepsis was the most frequent cause of death among these patients. We conclude that early catheter removal and/ or exploratory laparotomy are necessary whenever clinical signs of Gram-negative CAPD peritonitis do not clear within 48 hours of initiating therapy.