Chan T M, Chan C Y, Cheng S W, Lo W K, Lo C Y, Cheng I K
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Nephrol Dial Transplant. 1994;9(5):539-42. doi: 10.1093/ndt/9.5.539.
Twenty-one episodes of fungal peritonitis occurred over 35 months among 290 patients on CAPD, accounting for 6.3% of all peritonitis episodes. Patients with more frequent bacterial peritonitis were at higher risk of developing fungal peritonitis, and 28.6% of cases followed antimicrobial therapy. Candida species accounted for 85.7% of cases. Oral fluconazole was used as initial therapy in all patients, which was followed by catheter removal if peritonitis failed to improve. The cure rate with fluconazole therapy alone without catheter removal was 9.5%. Fluconazole plus catheter removal, the latter necessitated in 85.7% of cases, resulted in a cure rate of 66.7%. The remaining 3 (14.3%) patients responded to intravenous amphotericin given as salvage therapy. Disease-related mortality was 14.3%. Reinsertion of dialysis catheter was attempted in 15 patients and CAPD was successfully resumed in 13 (86.7%). We conclude that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD. Although catheter removal was necessary in the majority of patients, this sequential approach resulted in a relatively low prevalence of peritoneal adhesions and subsequent CAPD failure.
在接受持续性非卧床腹膜透析（CAPD）的290例患者中，35个月内发生了21例真菌性腹膜炎，占所有腹膜炎病例的6.3%。细菌性腹膜炎发作更频繁的患者发生真菌性腹膜炎的风险更高，28.6%的病例在抗菌治疗后出现。念珠菌属占病例的85.7%。所有患者均采用口服氟康唑作为初始治疗，若腹膜炎未改善则随后拔除导管。仅使用氟康唑治疗且不拔除导管的治愈率为9.5%。氟康唑加拔除导管（85.7%的病例需要这样做），治愈率为66.7%。其余3例（14.3%）患者对作为挽救治疗给予的静脉两性霉素有反应。疾病相关死亡率为14.3%。对15例患者尝试重新插入透析导管，13例（86.7%）成功恢复CAPD。我们得出结论，口服氟康唑可安全地用作并发CAPD的真菌性腹膜炎患者的初始治疗。虽然大多数患者需要拔除导管，但这种序贯方法导致腹膜粘连和随后CAPD失败的发生率相对较低。
