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Peritonealdialyseassoziierte Infektionen

Infections associated with peritoneal dialysis

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Infektionen, die mit einer Peritonealdialyse (PD) assoziiert sind, gelten als Achillesferse für den Erfolg eines PD-Programms. Jedes Zentrum sollte regelmäßig eine Infektionsstatistik führen. Die Peritonitis wird diagnostiziert, wenn zwei der drei Kriterien Klinik mit trübem Auslauf, Nachweis von Leukozyten im Dialysat, positive Dialysatkultur vorliegen. Die Initialtherapie sollte immer das grampositive und gramnegative Keimspektrum abdecken.

Bei der Katheterinfektion gibt es bislang keine einheitliche Definition. Zur Diagnose eines Tunnelinfekts und zur Therapiebeurteilung sollte eine Tunnelsonographie durchgeführt werden. Die International Society for Peritoneal Dialysis (ISPD) empfiehlt, dass man die Indikation zum PD-Katheterwechsel eher großzügiger stellen sollte.

Entscheidend für den Erfolg ist eine gute Prophylaxe für PD-assoziierte Infektionen. Hier hat sich herauskristallisiert, dass dem Training eine Schlüsselrolle zukommt. Regelmäßige Nachschulungen sollten unbedingt durchgeführt werden. Problematisch ist sicherlich die Empfehlung der ISPD, generell lokale Antibiotikacremes zu benutzen. Welchen Einfluss dies auf die Resistenzentwicklung hat, ist noch nicht abzusehen.

Abstract

Infections associated with peritoneal dialysis are often the Achilles heel for success of peritoneal dialysis. Every center should regularly monitor infections.

Peritonitis is diagnosed if two of the following three criteria are present: clinical symptoms and cloudy dialysate, increased white blood cells in the dialysate or positive dialysate culture. The initial antibiotic therapy should cover both gram-positive and gram-negative bacteria.

Currently there is no clear definition for peritoneal dialysis catheter infections. For the diagnosis for tunnel infections and to control the success of the therapy, tunnel sonography is obligatory. The International Society for Peritoneal Dialysis (ISPD) recommends that replacement of catheters for peritoneal dialysis should be considered more frequently and the focus should always be on preservation of the peritoneum rather than saving the peritoneal catheter.

Prophylaxis to reduce catheter infections is of great importance and training has a great impact on preventing infections. Re-training should be carried out regularly. The ISPD recommends local antibiotic therapy for all patients but the impact of this recommendation on the development of resistance is not clear.

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Interessenskonflikt

Die Autorin gibt an, dass sie als Referentin für die Firmen Fresenius Medical Care, Baxter Deutschland und AMGEN tätig ist und von diesen Firmen Vortragshonorare erhält.

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  1. KfH-Nierenzentrum Straubing, St. Elisabethstr. 23, 94315, Straubing, Deutschland

    M. Haag-Weber

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  1. M. Haag-Weber
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Correspondence to M. Haag-Weber.

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Haag-Weber, M. Peritonealdialyseassoziierte Infektionen. Nephrologe 7, 319–326 (2012). https://doi.org/10.1007/s11560-011-0629-0

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  • DOI: https://doi.org/10.1007/s11560-011-0629-0

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