Division of Nephrology, Department of Medicine, Bangkok, Thailand.
Center of Excellence in Kidney Metabolic Disorders, Bangkok, Thailand.
PLoS One. 2022 May 24;17(5):e0268823. doi: 10.1371/journal.pone.0268823. eCollection 2022.
We sought to evaluate the predictors and outcomes of mold peritonitis in patients with peritoneal dialysis (PD).
This cohort study included PD patients from the MycoPDICS database who had fungal peritonitis between July 2015-June 2020. Patient outcomes were analyzed by Kaplan Meier curves and the Log-rank test. Multivariable Cox proportional hazards model regression was used to estimating associations between fungal types and patients' outcomes.
The study included 304 fungal peritonitis episodes (yeasts n = 129, hyaline molds n = 122, non-hyaline molds n = 44, and mixed fungi n = 9) in 303 patients. Fungal infections were common during the wet season (p <0.001). Mold peritonitis was significantly more frequent in patients with higher hemoglobin levels, presentations with catheter problems, and positive galactomannan (a fungal cell wall component) tests. Patient survival rates were lowest for non-hyaline mold peritonitis. A higher hazard of death was significantly associated with leaving the catheter in-situ (adjusted hazard ratio [HR] = 6.15, 95%confidence interval [CI]: 2.86-13.23) or delaying catheter removal after the diagnosis of fungal peritonitis (HR = 1.56, 95%CI: 1.00-2.44), as well as not receiving antifungal treatment (HR = 2.23, 95%CI: 1.25-4.01) or receiving it for less than 2 weeks (HR = 2.13, 95%CI: 1.33-3.43). Each additional day of antifungal therapy beyond the minimum 14-day duration was associated with a 2% lower risk of death (HR = 0.98, 95%CI: 0.95-0.999).
Non-hyaline-mold peritonitis had worse survival. Longer duration and higher daily dosage of antifungal treatment were associated with better survival. Deviations from the 2016 ISPD Peritonitis Guideline recommendations concerning treatment duration and catheter removal timing were independently associated with higher mortality.
我们旨在评估腹膜透析（PD）患者中霉菌腹膜炎的预测因素和结果。
这项队列研究纳入了 2015 年 7 月至 2020 年 6 月期间 MycoPDICS 数据库中患有真菌性腹膜炎的 PD 患者。通过 Kaplan-Meier 曲线和对数秩检验分析患者的预后。采用多变量 Cox 比例风险模型回归估计不同真菌类型与患者预后之间的关联。
本研究共纳入 303 名患者的 304 例真菌性腹膜炎发作（酵母 n=129，透明丝孢霉 n=122，非透明丝孢霉 n=44，混合真菌 n=9）。真菌感染在雨季更为常见（p<0.001）。血红蛋白水平较高、导管问题表现以及半乳甘露聚糖（真菌细胞壁成分）检测阳性的患者，霉菌腹膜炎更为常见。非透明丝孢霉性腹膜炎患者的生存率最低。与保留导管原位（调整后的危险比[HR] = 6.15，95%置信区间[CI]：2.86-13.23）或在诊断为真菌性腹膜炎后延迟导管移除（HR = 1.56，95%CI：1.00-2.44）、未接受抗真菌治疗（HR = 2.23，95%CI：1.25-4.01）或治疗时间少于 2 周（HR = 2.13，95%CI：1.33-3.43）显著相关的死亡风险更高。抗真菌治疗时间每延长一天，死亡风险降低 2%（HR = 0.98，95%CI：0.95-0.999）。
非透明丝孢霉性腹膜炎的生存率更差。延长抗真菌治疗的时间和增加每日剂量与更好的生存率相关。治疗时间和导管移除时机偏离 2016 年 ISPD 腹膜炎指南建议与更高的死亡率独立相关。
