Pediatric Nephrology, Seattle Children's, Seattle, WA, USA.
Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
Pediatr Nephrol. 2018 May;33(5):873-880. doi: 10.1007/s00467-017-3872-4. Epub 2018 Jan 8.
Fungal peritonitis is a serious complication among peritoneal dialysis (PD) patients. The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multicenter quality improvement initiative with the primary aim to reduce catheter-related infections in children on chronic dialysis.
To describe the epidemiology of fungal peritonitis and outcomes of affected patients among pediatric subjects receiving chronic PD and enrolled in SCOPE.
Data pertaining to PD characteristics, peritonitis episodes and patient outcome were collected between October 2011 and September 2015 from 30 pediatric dialysis centers participating in the SCOPE collaborative. Peritonitis-related data were stratified by etiology, fungal versus bacterial/culture-negative peritonitis. Differences among groups were assessed by Chi-square analysis.
Of 994 patients enrolled in the registry, there were 511 peritonitis episodes of which 41 (8.0%) were fungal. Thirty-six individual patients with 39 unique catheters accounted for the fungal peritonitis episodes. Twenty-three (59%) of the episodes occurred in patients aged < 2 years (p = 0.03). Fungal peritonitis was the initial episode of peritonitis in 48.8% of affected patients, and only 17.1% of these patients had had a previous peritonitis episode within 30 days of the fungal infection. Insertion of the PD catheter at < 2 years of age was associated with an adjusted odds ratio of 2.8 (95% confidence interval 1.24, 6.31) for development of fungal peritonitis compared to older children (p = 0.01). Fungal peritonitis was associated with an increased rate of hospitalization (80.5 vs. 63.4%; p = 0.03), increased length of hospitalization (median of 8 vs. 5 days; p < 0.001) and increased rates of catheter removal (84.6 vs 26.9%; p = 0.001) and technique failure (68.3 vs. 8%; p = 0.001) compared to other causes of peritonitis.
Fungal infections were responsible for 8.0% of peritonitis episodes in the SCOPE collaborative, with the majority of fungal peritonitis episodes occurring in children aged < 2 years. Although no risk factors for infection other than young age were identified, fungal peritonitis was associated with an increased risk of hospitalization, longer hospital stay and an increased frequency of technique failure.
真菌性腹膜炎是腹膜透析（PD）患者的一种严重并发症。标准化护理以改善儿科终末期肾病（SCOPE）协作的结果是一个北美的多中心质量改进计划，其主要目标是减少儿童慢性透析患者的导管相关感染。
描述接受慢性 PD 治疗并参与 SCOPE 的儿科患者中真菌性腹膜炎的流行病学和患者结局。
在 2011 年 10 月至 2015 年 9 月期间，从参与 SCOPE 合作的 30 个儿科透析中心收集了与 PD 特征、腹膜炎发作和患者结局相关的数据。根据病因将腹膜炎相关数据分层为真菌性与细菌性/培养阴性腹膜炎。通过卡方检验评估组间差异。
在登记的 994 名患者中，有 511 例腹膜炎发作，其中 41 例（8.0%）为真菌性。36 名患者有 39 个独特的导管，发生了真菌性腹膜炎发作。23 例（59%）的发作发生在<2 岁的患者中（p=0.03）。真菌性腹膜炎是 48.8%受影响患者的首发腹膜炎，其中只有 17.1%的患者在真菌感染后 30 天内有过先前的腹膜炎发作。与年龄较大的儿童相比，<2 岁时植入 PD 导管的患者发生真菌性腹膜炎的调整优势比为 2.8（95%置信区间 1.24，6.31）（p=0.01）。与其他原因引起的腹膜炎相比，真菌性腹膜炎与更高的住院率（80.5%比 63.4%；p=0.03）、更长的住院时间（中位数 8 天比 5 天；p<0.001）和更高的导管拔除率（84.6%比 26.9%；p=0.001）和技术失败率（68.3%比 8%；p=0.001）相关。
在 SCOPE 协作中，真菌感染导致 8.0%的腹膜炎发作，大多数真菌性腹膜炎发作发生在<2 岁的儿童中。尽管除了年龄较小之外，没有确定其他感染的危险因素，但真菌性腹膜炎与更高的住院风险、更长的住院时间和更高的技术失败频率相关。
