关键词: 隧道感染, 出口部位感染, 腹膜透析

Abstract: 【Abstract】Objective To investigate the epidemiology and clinical outcome of catheter-related tunnel infection (TI) in peritoneal dialysis (PD) patients. Methods The PD patients with and without TI and peritonitis identified during 2010-2021 in Xijing Hospital were retrospectively studied. Their baseline characteristics, pathogenic microorganisms, antibiotics susceptibility/resistance and treatment outcome were analyzed. Results A total of 41 TI episodes happened in 36 PD patients, of which 28 were males and 8 were females with an average age of 41.44±13.75 years. The incidence rate of TI was once every 278 patient months. Ultrasonography was conducted in 14 patients, of which 11 cases were found to have defined sonolucent zones around the outer cuffs with an average thickness of 2.89±1.97mm. Pathogenic microorganism culture was positive in 68.3% samples, in which 75.0% were Gram positive bacteria, especially Staphylococcus aureus (60.7%). After admission, the patients were empirically given gentamicin drip at the entrance of the tunnel and local treatment with Mupirocin ointment, and then the treatment was adjusted according to the results of drug sensitivity of the pathogens. The total cure rate was 85.4%, including the empirical cure rate of 63.4%. Catheter removal was required in 4 (9.8%) patients, and one patient (2.4%) died of catheter-related peritonitis. Conclusions TI is one of the common complications of PD. Better PD training program and nursing care of the catheter exit are the key measures to prevent TI. Ultrasonography of the tunnel sites is an effective tool for the diagnosis of TI. Gram-positive organisms are the major pathogens of the infections. Active treatment can extend the survival time of the catheter in most PD patients.

Key words: Tunnel infection, Exit site infection, Peritoneal dialysis