García-Agudo R, García-Martos P
Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real.
Nefrologia. 2009;29(6):506-17. doi: 10.3265/Nefrologia.2009.29.6.5650.en.full.
Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and important mortality. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in the literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.
腹膜炎是腹膜透析最严重的并发症之一。大多数腹膜炎病例由病原菌引起。真菌感染较为罕见，但发病率高，无法继续进行透析治疗，且死亡率高。其发病率在儿童所有腹膜炎发作中占4%至10%，在成人中占1%至23%。其临床表现与细菌性腹膜炎相似。迄今为止，真菌性腹膜炎的易感因素尚未明确；文献中经常报道有细菌性腹膜炎发作史和使用广谱抗生素治疗的情况。念珠菌属是最常见的病原体，白色念珠菌最为常见，但在过去十年中，近平滑念珠菌的患病率较高。微生物学检查结果对于确定腹膜炎的病因至关重要。成功治疗真菌性腹膜炎需要抗真菌治疗、拔除腹膜导管并随后转为血液透析。推荐使用氟康唑和两性霉素B作为抗真菌药物。伏立康唑和卡泊芬净等新药非常有效。本系统评价的目的是分析真菌性腹膜炎的临床和微生物学方面，因为这些方面尚不为人所知，且在过去几年中有所变化。
