Division of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300391, China.
Infection. 2019 Feb;47(1):35-43. doi: 10.1007/s15010-018-1204-7. Epub 2018 Aug 25.
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.
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.
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.
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.
真菌性腹膜炎（FP）是腹膜透析（PD）中一种罕见但具有破坏性的并发症，可导致较高的技术失败率、发病率和死亡率。本研究旨在探讨 PD 患者 FP 的腹膜炎发生率、微生物学检测、患者特征、临床特征、抗真菌治疗和临床结局。
本单中心回顾性研究纳入 2012 年 6 月 1 日至 2017 年 6 月期间诊断的所有 FP 病例。将所有 FP 病例与诊断为细菌性腹膜炎的 PD 患者按 1:5 比例进行匹配。记录临床、生化特征和腹膜炎发作的详细数据。
共发现 11 例真菌性腹膜炎（透析患者中 0.0067 例/年）。所有 FP 均由念珠菌引起（采用 VITEK 2 compact 系统进行鉴定和抗真菌药敏试验），包括白念珠菌（6/11）、近平滑念珠菌（4/11）和光滑念珠菌（1/11）。除光滑念珠菌外，未检测到氟康唑耐药的念珠菌。与细菌性腹膜炎（匹配病例，n=55）相比，FP 组既往抗生素使用比例更高（p=0.002），总透出液细胞计数更高（p=0.007），血清白蛋白水平更低（p=0.01），感染相关性手术比例更高（p<0.001）、HD 转换比例更高（p=0.001），以及全因死亡率更高（p=0.006）。FP 患者中还观察到女性比例高（≥50%）、无尿、CCI≥4、低白蛋白血症、贫血和低钾血症。超过一半的 FP 患者有胃肠道症状（7/11）和腹膜外感染（6/11）。8 例（72.7%）患者行导管手术切除，中位延迟 5.5 天，4 例（36.4%）患者在 3 个月内死亡，6 例（54.5%）患者导致技术失败。
FP 导致导管丢失和 3 个月内全因死亡率的发生率较高，在本中心，最常见的病原体是念珠菌。观察到临床特征和药敏模式的变化。胃肠道疾病可能是 FP 的潜在危险因素。
