Sürekli Ayaktan Periton Diyalizi Uygulanan Hastalarda Gelişen Peritonit Ataklarının Değerlendirilmesi ve Gram Negatif Bakteri Peritoniti İçin Risk Faktörlerinin Araştırılması

ÖzGiriş: Sürekli Ayaktan Periton Diyalizi (SAPD) uygulaması, kronik böbrek yetmezliği tedavisinde uygulanan yöntemler arasında yerini almıştır. Tüm teknik gelişmelere rağmen peritonitler, halen en önemli komplikasyondur. Hastalarda mikroorganizmanın saptanması; uygun antimikrobiyal tedavinin başlanabilmesi, morbidite ve mortalitenin azaltılabilmesi açısından önemlidir.Materyal ve Metod/Hastalar ve Metod: Çalışmamızda, Gazi Üniversitesi Tıp Fakültesi Hastanesi Nefroloji Kliniği, SAPD ünitesinde izlenen ve peritonit semptomlarıile başvuran hastalar yer almıştır. Hastalarda periton sıvısı kan kültür şişelerine ve rutin kültür plaklarına ekilmiştir. Gelişen Gram negatif bakteri peritonitleri açısından çeşitli risk faktörleri sorgulanmıştır.Bulgular: Otuzbeş hastada 46 peritonit atağı takip edilmiştir. Kan kültürü ve konvansiyonel kültür yöntemleri ile izolasyon oranları %78.3 ve %63 olarak saptanmıştır.(p=0,001) Atakların %69.6’sında gram pozitif, %27.7’sinde ise gram negatif etkenler izole edilmiştir. Gram negatif peritonit açısından; ileri yaş ve CRP yüksek-liği risk faktörü olarak bulunmuştur.Sonuç: SAPD uygulayan hastalarda peritonit en önemli komplikasyondur. Kan kültürü sistemleri izolasyon şansını artırmaktadır. İleri yaş ve CRP yüksekliği saptanan hastalarda gram negatif peritonit ihtimali yüksektir.

Anahtar Kelimeler:

periton diyalizi, peritonit, risk faktörleri

Evaluation Of Continuous Ambulatory Peritoneal Dialysis Associated Peritonitis Attacks and Investigation Of Risk Factors For Gram Negative Bacterial Peritonitis

AbstractIntroduction :Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of the methods currently used in the treatment of chronic renal failure. Despite all technical advances, peritonitis continues to be the most important complication of this procedure. It is important to detect the responsible microorganism andits antimicrobial sensitivity, to start the appropriate antimicrobial treatment, to decrease the morbidity and mortality inpatients who develop peritonitis. Materials and Methods:In our study, chronic renal failure patients who were on the CAPD program in Gazi University Medical Faculty Hospital Nephrology Clinic, peritonitis symptoms were present and has peritonitis symptoms. Peritoneal fluid was, inoculation into automated blood culture bottles and viewed together with traditional culture met-hods. Risk factors for Gram negative bacterial peritonitis werequestioned. Results:Forty-six peritonitis episodes were observed in 35 patients undergoing CAPD, and clinical and laboratoryparameters were evaluated. Culture isolation rates were de-termined as % 78.3 and %63 in the evaluations performedusing blood culture systems and conventional culture methods, respectively.(p=0,001) Gram positive microorganisms were detected in %69.6 and gram negative microorganisms were detected in %27.7 of the peritonitis attacks.It was determined as an advanced age risk factor in termsof Gram negative peritonitis development (p= .000) CRP le-vels were significantly higher in gram-negative peritonitisepisodes ( p=0,004).Conclusion:Peritonitis still remains the most importantcomplication in patients undergoing CAPD. The use of blood culture systems increases the chances of microorganismisolation. Patients with advanced age and high CRP levelsare more likely to have gram-negative peritonitis.

Keywords:

peritoneal dialysis, perito-nitis, risk factors,

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