Spontaneous bacterial peritonitis in CAPD patients

腹水患者では, 明らかな感染源なしの自然発症細菌性腹膜炎 (SBP) の存在が知られている. そこでCAPD患者におけるSBPの可能性と頻度を検討した. 最近4年間に発症した連続76件のCAPD腹膜炎の発症原因を分析し, 無菌性connection deviceを使用し, かつ操作ミスがなく, 出口部・トンネル感染なし, 透析液バッグや回路の破損を認めない例をSBPと診断した. 対象76件のうち, 28件 (36.8%) が接触汚染, 14件 (18.4%) が出口部・トンネル感染からの波及による腹膜炎であったのに対し, 34件 (44.7%) がSBPと診断された. SBPの起炎菌はStreptococcusやE. coli, Klebsiellaを多く認めた. CAPD腹膜炎の約半数近くがSBPと考えられ, これはnew deviceの開発や出口部感染阻止では予防できないため, 今後その対策を考慮する必要があると考えられた.

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