Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Yonsei University, Seoul, Korea.
Perit Dial Int. 2011 Jan-Feb;31(1):60-6. doi: 10.3747/pdi.2009.00057. Epub 2010 May 26.
Fungal peritonitis (FP) is an uncommon but serious complication of peritoneal dialysis (PD) and is associated with high morbidity and mortality. Although previous studies have demonstrated that abdominal pain and catheter in situ are associated with mortality in FP patients, the effect of early catheter removal on mortality remains largely unexplored. In this study, therefore, we not only determine the risk factors for mortality but also investigate the effect of immediate catheter removal on mortality in PD patients with FP.
This retrospective study was conducted on 94 episodes of FP in 1926 patients that underwent PD at Yonsei University Health System from January 1992 to December 2008. Data including demographic characteristics, laboratory and clinical findings, management, and outcome were collected from medical records.
Among a total of 2361 episodes of peritonitis, there were 94 episodes of FP in 92 patients, which accounted for 4.0% of all peritonitis episodes and occurred in 4.8% of patients. Mean age of patients was 52.1 years and mean duration of PD before contracting FP was 46.1 months. The presenting symptoms included turbid dialysate (93.6%), abdominal pain (84.0%), and fever (66.0%). Intestinal obstruction was complicated in 39 episodes (41.5%). 75% of FP was caused by Candida species, among which Candida albicans was the most common pathogen, accounting for 41.5% of all episodes of FP. The PD catheter was removed within 24 hours in 39 patients (41.5%), whereas catheter removal was performed between 2 and 9 days after the diagnosis of FP in 42 patients (44.7%). 27 patients (28.7%) died as a result of FP, 59 patients (62.8%) required a change to hemodialysis, and PD was resumed in 8 episodes (8.5%). In addition, the mortality rate was significantly higher in patients with delayed catheter removal (13/41, 31.7%) compared to patients with catheter removal within 24 hours (5/39, 12.8%) (p < 0.01). Multivariate logistic regression analysis revealed that delayed catheter removal, the presence of intestinal obstruction, and higher white blood cell counts in the blood and in the PD effluent were independently associated with mortality in FP patients.
These results suggest that immediate catheter removal (i.e., within 24 hours after the diagnosis of FP) is mandatory in PD patients with FP.
真菌性腹膜炎（FP）是腹膜透析（PD）的一种罕见但严重的并发症，与高发病率和死亡率相关。尽管先前的研究表明，腹痛和导管在位与 FP 患者的死亡率相关，但早期导管去除对死亡率的影响在很大程度上仍未得到探索。因此，在这项研究中，我们不仅确定了死亡率的危险因素，还研究了 PD 患者 FP 中立即去除导管对死亡率的影响。
这项回顾性研究纳入了 1926 例在延世大学健康系统接受 PD 的患者中的 94 例 FP 发作，研究时间为 1992 年 1 月至 2008 年 12 月。研究从病历中收集了人口统计学特征、实验室和临床发现、治疗和结局等数据。
在总共 2361 例腹膜炎发作中，92 例患者发生了 94 例 FP，占所有腹膜炎发作的 4.0%，占患者的 4.8%。患者的平均年龄为 52.1 岁，发病前 PD 治疗时间为 46.1 个月。首发症状包括透析液混浊（93.6%）、腹痛（84.0%）和发热（66.0%）。39 例（41.5%）并发肠梗阻。75%的 FP 由念珠菌引起，其中白色念珠菌最常见，占 FP 发作总数的 41.5%。94 例 FP 中有 39 例（41.5%）在 24 小时内去除 PD 导管，42 例（44.7%）在 FP 诊断后 2-9 天去除导管。27 例（28.7%）因 FP 死亡，59 例（62.8%）需要改为血液透析，8 例（8.5%）恢复 PD。此外，延迟导管去除的患者死亡率明显更高（13/41，31.7%），明显高于导管去除时间在 24 小时内的患者（5/39，12.8%）（p<0.01）。多变量逻辑回归分析显示，延迟导管去除、存在肠梗阻以及血液和 PD 流出液中白细胞计数升高与 FP 患者的死亡率独立相关。
这些结果表明，PD 患者 FP 中必须立即（即在 FP 诊断后 24 小时内）去除导管。
