Gallieni M, Chiarelli G, Olivi L, Cozzolino M, Cusi D
Dipartimento Medicina Chirurgia Odontoiatria, Università degli Studi di Milano, Italy.
Clin Nephrol. 2011 Jan;75(1):70-3.
Fungal peritonitis (FP) is a serious complication for peritoneal dialysis (PD) patients, determining hospitalization, technique failure, catheter loss and death. In the 2005 update, treatment recommendations for FP from the International Society of Peritoneal Dialysis (ISPD) advocate catheter removal immediately after fungi are identified by microscopy or culture. The availability of more effective medical treatments could therefore be of great importance. The aim of this report is to describe a case of a 43-year-old, diabetic, HIV positive PD patient with fluconazole resistant Candida peritonitis, who was treated with an i.p. taurolidine solution. Taurolidine is a non-antibiotic antimicrobial, with broad bactericidal and fungicidal properties. It has been used during surgery for lavage of the peritoneum in cases of peritonitis. Its mechanism of action is related to direct toxic action on micro-organisms, through a chemical reaction between active taurolidine derivatives and structures on the cell wall. Treatment failed because the patient had severe burning pain during i.p. administration of the drug, limiting its dose. PD catheter removal allowed complete recovery. It remains undetermined if, with different doses and methodology, taurolidine could be more effective in treating bacterial and/or fungal peritonitis. Currently, catheter removal remains the most effective therapy of fungal peritonitis.
真菌性腹膜炎（FP）是腹膜透析（PD）患者的一种严重并发症，可导致住院、技术失败、导管拔除及死亡。在2005年的更新版中，国际腹膜透析学会（ISPD）对FP的治疗建议主张在通过显微镜检查或培养鉴定出真菌后立即拔除导管。因此，获得更有效的药物治疗可能非常重要。本报告的目的是描述一例43岁、患有糖尿病、HIV阳性的PD患者，其患有对氟康唑耐药的念珠菌性腹膜炎，接受了腹腔内牛磺罗定溶液治疗。牛磺罗定是一种非抗生素类抗菌剂，具有广泛的杀菌和杀真菌特性。它已在腹膜炎病例的手术中用于冲洗腹膜。其作用机制与活性牛磺罗定衍生物与细胞壁结构之间的化学反应对微生物的直接毒性作用有关。治疗失败是因为患者在腹腔内给药期间出现严重灼痛，限制了药物剂量。拔除PD导管后患者完全康复。目前尚不确定采用不同剂量和方法时，牛磺罗定在治疗细菌性和/或真菌性腹膜炎方面是否会更有效。目前，拔除导管仍然是真菌性腹膜炎最有效的治疗方法。
