Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis

来源 :World Journal of Nephrology | 被引量 : 0次 | 上传用户:eline77
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Peritonitis continues to be a major complication of peritoneal dialysis(PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional metaanalysis published by our group. Results from systematic reviews of randomized control trials(RCT) and quasiRCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate(86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides(66%) and glycopeptides plus aminoglycosides(75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gramnegative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate. Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyzes. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. proportional metaanalysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasiRCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase , simultaneous catheter removal and replacement resulted in better outcomes. Continuo us and intermittent IP antibiotic use had similar outcomes. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was Significally higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gramnegative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.
其他文献
且慢“烧火”文/纪良英“新官上任三把火”,是一句流传了多年的老话,在某种意义上自有其合理性与适用性。笔者却想在这里唱几句反调。假如在一个企业,新官上任,万象伊始,因为比较容
有一次,汉武帝乘着车子到郎署去,看见一个头发、胡子都白了的老人,穿的衣服也不像个样子。汉武帝就问他:“你什么时候到这里当郎这个小官的?现在怎么这样老了呢?”老人回答说:“我姓
由青岛市政府与美国迈阿密市政府共同主办的2011“东洲富隆”青岛葡萄酒美食节暨中国青岛国际葡萄酒博览会将于5月27日至29日在奥帆中心与市民见面。本次葡萄酒美食节的展品
一个不能善断的上司,必然带出一批优柔寡断的下属,而犹豫不决的队伍是不能打胜仗的。果断不是鲁莽,果断是一种智慧和胆识的体现。稳健不是不作决策,有些时候不决策即是失策,因此,稳
目的探讨H7N9亚型人禽流感的胸部CT早期表现。方法 8例经临床确诊的H7N9亚型人禽流感患者在发病后1周内接受胸部CT检查,回顾性分析其胸部CT图像,分析内容包括病变数目、分布
协调是领导者为了完成工作的总目标,及时解决各个部门之间发生的矛盾,使之互相配合,从而顺利地完成任务的手段。它是领导干部的重要职能之一,也是领导者必备的能力。协调的
By using methods of carbon footprint analysis,and impacts of population,affluence and technology(IPAT),this article analyzes the carbon footprints of residence
Determining the prognosis of cirrhotic patients is not an easy task. Prognostic scores, like Child-Pugh and Model of End-stage Liver Disease scores, are commonl
峡山水库坐落于山东半岛,是山东省第一大水库,在潍坊市潍河中游的昌邑、高密、诸城、安丘4县市交界处。库区气候宜人,风景优美,物产丰富,花草树木繁多,是集观光旅游、休闲垂
Despite the level of sophistication they have reached nowadays, the available tools for treatment of inflammatory bowel disease(IBD) can at best chronicize the