腹膜透析病患導管出口處感染原因與預後之相關因素調查

Factors Related to exit-site Infection and Prognosis in Peritoneal Dialysis Patients

本研究為病歷回溯性研究，其目的在了解廔管出口處感染的原因及影響預後之因素。研究對象115人為曾發生廔管出口處感染之病患，研究內容包括感染原因、菌種、使用抗生素情形、預後及腹膜透析廔管拔除的原因。所得資料以SPSS 12.0分析，結果發現(1)感染原因以淋浴後未保持廔管出口處乾燥及拉扯為最多75.6%，細菌培養以金黃色葡萄球菌佔49.5%最多，有97.6%病患經抗生素治療後可痊癒，(2)廔管拔除之病患有80%曾發生3次以上感染，使用抗生素種類較多之病患較易廔管拔除，廔管拔除的主要原因為廔管出口處感染久治不癒及感染引發的腹膜炎。結論：廔管出口處感染經由抗生素治療後痊癒率高，細菌的種類、感染次數及使用抗生素的種類等皆會影響廔管出口處感染的預後。

The study is a retrospective observational investigation to review the causes of exit-site infection (ESI) and its prognostic factors in 115 peritoneal dialysis (PD) patients. Data examined included causes of ESI, pathogens, types of antibiotics, prognosis and causes of PD catheter loss. Statistical analysis was carried out with SPSS 12.0. The results found that (1) showering and improper traction of the PD catheter were the major causes (75.6%) of ESI with the most common pathogen of ESI being S. aureus (49.5%) and the cure rate of ESI was 97.6%; (2) most of patients (80%) with PD catheter loss had more than three episodes of ESI and those that used more antibiotics being more prone to PD catheter loss, the cause being refractory response to antibiotic treatment at the exit site and peritonitis caused by infection. In conclusion, a majority of ESI episodes could be resolved by antibiotic treatment. The impact factors of ESI prognosis were pathogens, frequency of ESI and types of antibiotics.