Amici G, Grandesso S, Mottola A, Virga G, Calconi G, Bocci C
Nephrology and Dialysis Division, Regional Hospital, Treviso, Italy.
Adv Perit Dial. 1994;10:169-73.
Fungal peritonitis (FP) is uncommon in patients on peritoneal dialysis (PD); it is difficult to treat and has a high mortality rate. We report 6 cases of fungal peritonitis observed between 1980 and 1992 in our center. The etiologic agents were: Candida spp., C. guilliermondi, C. parapsilosis, C. albicans, and Verticillium spp. All 6 patients had suffered at least one episode of bacterial peritonitis in the two months before the fungal infection appeared and were all treated by intraperitoneal administration of antibiotics. The catheter was removed early in 3 patients followed by antimycotic therapy, while the remaining 3 patients received antimycotic therapy, with removal of the catheter in a later stage. The result in the first group was that they all switched permanently to hemodialysis, while in the second group there were 2 deaths and 1 transfer to hemodialysis. In the light of these 6 cases, we analyzed 22 published reports to assess risk factors, therapy, and outcome of this pathology. The major predisposing factors were intraperitoneal antibiotics and bacterial peritonitis, and the best results were obtained by continuing PD plus intraperitoneal and systemic antifungal agents.
真菌性腹膜炎（FP）在腹膜透析（PD）患者中并不常见；其治疗困难且死亡率高。我们报告了1980年至1992年期间在本中心观察到的6例真菌性腹膜炎病例。病原体为：念珠菌属、季也蒙念珠菌、近平滑念珠菌、白念珠菌和轮枝菌属。所有6例患者在真菌感染出现前的两个月内至少发生过一次细菌性腹膜炎，均接受了腹腔内抗生素治疗。3例患者早期拔除导管，随后进行抗真菌治疗，其余3例患者接受抗真菌治疗，后期拔除导管。第一组的结果是他们都永久性地转为血液透析，而第二组有2例死亡，1例转为血液透析。根据这6例病例，我们分析了22篇已发表的报告，以评估这种疾病的危险因素、治疗方法和结果。主要的诱发因素是腹腔内使用抗生素和细菌性腹膜炎，持续进行腹膜透析加腹腔内和全身性抗真菌药物治疗可取得最佳效果。
