Department of Medicine, Division of Nephrology, Queen's University, Kingston, Ontario, Canada.
School of Public Health, Johns Hopkins Bloomberg, Baltimore, Maryland, USA.
Nephrology (Carlton). 2022 Feb;27(2):133-144. doi: 10.1111/nep.13997. Epub 2021 Dec 6.
The clinical syndrome of Mycobacterium tuberculosis (M. tuberculosis) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local tuberculosis (TB) patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown.
A scoping review identified published cases of TB PD peritonitis. Cases from low- and high-TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared.
There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low-TB burden regions (7.3 vs. 3.7 weeks). In low-TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3% vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9% vs. 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs. 45.1 years) and less likely female (37.8% vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0% vs. 49.1%).
Outcomes in TB PD peritonitis are best predicted by national TB incidence, patient age and sex. Several unique features are identified to alert clinicians to use more rapid diagnostic methods that might enhance outcomes in TB PD peritonitis.
结核分枝杆菌（Mycobacterium tuberculosis，M. tuberculosis）腹膜透析（peritoneal dialysis，PD）相关性腹膜炎的临床综合征尚未被充分认识。局部结核（tuberculosis，TB）模式是否会改变临床综合征，以及哪些因素与不良预后相关，目前也不清楚。
通过系统综述，我们确定了已发表的结核 PD 相关性腹膜炎病例。比较了低结核负担和高结核负担地区的病例，并比较了临床结局良好和不良的病例。
共确定了 216 例病例。描述了这些病例的人口统计学特征、临床表现、诊断、治疗和结局。诊断的显著延迟很常见（6.1 周），且在低结核负担地区的患者中更长（7.3 周 vs. 3.7 周）。在低结核负担地区，更常使用 PD 液培养等较慢的诊断方法（64.3% vs. 32.7%），且不太可能使用喹诺酮类抗生素治疗（6.9% vs. 34.1%）。在发生 PD 导管拔除或死亡的病例中，国家结核发病率更高，人均 GDP 更低。在发生 PD 导管拔除或死亡的病例中，诊断延迟并不更长。死亡病例的年龄更大（51.9 岁 vs. 45.1 岁），女性比例更低（37.8% vs. 55.7%）。死亡病例更常发生 PD 导管拔除（62.0% vs. 49.1%）。
结核 PD 相关性腹膜炎的结局主要由国家结核发病率、患者年龄和性别决定。识别出几个独特的特征，可以提醒临床医生使用更快速的诊断方法，从而可能改善结核 PD 相关性腹膜炎的结局。
