目的:真菌性腹膜炎(FP)是腹膜透析(PD)中一种罕见但破坏性的并发症,考虑到高的技术故障率,发病率和死亡率。这项研究是为了调查FPs关于腹膜炎率,微生物学测试,患者特征,临床特征,抗真菌治疗,和PD患者的临床结果。
方法:这项单中心研究回顾性分析了2012年6月1日至6月诊断的所有FP发作,2017.所有FP与诊断为细菌性腹膜炎的PD患者以1:5的比例匹配。临床,记录生化特征和腹膜炎发作的详细数据.
结果:确定了11次真菌性腹膜炎发作(每个患者透析年的发生率为0.0067次)。所有FPs均由念珠菌属引起(使用VITEK2®紧凑型系统进行鉴定和抗真菌药敏试验),包括白色念珠菌(6/11),C.近平滑(4/11)和C.krusei(1/11)。除了C.Krusei,未检测到念珠菌对氟康唑耐药。与细菌性腹膜炎相比(匹配病例,n=55),FP组以前使用抗生素的比率更高(p=0.002),较高的总流出物细胞计数(p=0.007),和较低的血清白蛋白(p=0.01),感染相关手术的发生率较高(p<0.001),高清传输(p=0.001),全因死亡(p=0.006)。女性高患病率(≥50%),无尿症,CCI≥4,低蛋白血症,贫血,在FP患者中也观察到低钾血症。超过一半的FP患者出现胃肠道症状(7/11)和腹膜外感染(6/11)。8例(72.7%)患者手术切除导管,平均滞后5.5天,4例(36.4%)患者在3个月内死亡,6例(54.5%)导致技术失败.
结论:FP在3个月的随访中导致导管丢失和全因死亡率高,念珠菌是我们中心最常见的病原体。观察到临床特征和易感性模式的变化。胃肠道疾病可能是FP的潜在危险因素。
OBJECTIVE: Fungal peritonitis (FP) is a rare but devastating complication in peritoneal dialysis (PD), accounting for high rates of technique failure, morbidity and mortality. This study was conducted to investigate FPs with regard to peritonitis rate, microbiology testing, patient characteristics, clinical features, antifungal treatments, and clinical outcomes in patients on PD.
METHODS: This single-center study retrospectively reviewed all FP episodes diagnosed from June 1, 2012 to June, 2017. All FPs were matched in a 1:5 ratio with PD patients diagnosed with bacterial peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded.
RESULTS: Eleven fungal peritonitis episodes (rate of 0.0067 episodes per patient-year on dialysis) were identified. All FPs were caused by Candida species (identification and antifungal susceptibility testing were performed with VITEK 2® compact system), including C. albicans (6/11), C. parapsilosis (4/11) and C. krusei (1/11). Except C. krusei, no Candida resistance to fluconazole was detected. Compared to bacterial peritonitis (matched cases, n = 55), FP group showed higher rate of previous antibiotic use (p = 0.002), higher total effluent cell count (p = 0.007), and lower serum albumin (p = 0.01), higher rate of infection-related surgery (p < 0.001), HD transfer (p = 0.001), and all-cause death (p = 0.006). High prevalence (≥ 50%) of female gender, anuria, CCI ≥ 4, hypoalbuminemia, anemia, and hypokalemia were also observed in FP patients. More than half of the FP patients presented gastrointestinal symptoms (7/11) and extraperitoneal infection (6/11). Eight (72.7%) patients had catheter surgically removed with a median 5.5 lag days, four (36.4%) patients died within 3 months and six (54.5%) cases led to technique failure.
CONCLUSIONS: FP results in high rates of catheter loss and all-cause mortality in 3 months of follow-up, candida species were the commonest pathogens in our center. Variations of clinical features and susceptibility patterns were observed. Gastrointestinal disorders maybe a potential risk factor for FP.