Hoch B S, Namboodiri N K, Banayat G, Neiderman G, Louis B M, Manohar N L, Lipner H I
Department of Medicine, Maimonides Medical Center, Brooklyn, New York 11219.
Perit Dial Int. 1993;13 Suppl 2:S357-9.
In patients receiving peritoneal dialysis, fungal peritonitis is generally impossible to eradicate with previously available therapy in the absence of catheter removal. Corbella et al. described a patient with fungal peritonitis treated with fluconazole without catheter removal. We studied this drug's effectiveness in the treatment of 5 patients with peritonitis secondary to Candida species. Patients received a loading dose of 200-400 mg fluconazole, followed by 50-200 mg fluconazole daily. Patients improved initially after therapy with fluconazole. Abdominal pain and fever abated, dialysis returns cleared, cell counts decreased, and, in four cases, cultures were sterilized. Dialysate fluconazole levels were adequate. However, despite maintenance of fluconazole therapy, all patients had recurrent peritonitis within 1 month. Complete cure did not occur unless the Tenckhoff catheter was removed. When the catheter was removed, tip cultures grew pure Candida species, and microscopic examination of catheter sections revealed abundant yeast. Although there may be continued isolated reports of successful eradication of fungal peritonitis without catheter removal, we conclude that in the vast majority of cases catheter removal is required.
在接受腹膜透析的患者中，若不拔除导管，以往可用的治疗方法通常无法根除真菌性腹膜炎。科尔贝拉等人描述了一名未拔除导管而接受氟康唑治疗的真菌性腹膜炎患者。我们研究了该药对5例念珠菌属所致腹膜炎患者的治疗效果。患者接受200 - 400毫克氟康唑的负荷剂量，随后每日服用50 - 200毫克氟康唑。患者在接受氟康唑治疗后最初有所改善。腹痛和发热减轻，透析液回流清澈，细胞计数下降，且在4例患者中培养物转为无菌。透析液中的氟康唑水平充足。然而，尽管维持氟康唑治疗，所有患者在1个月内均出现复发性腹膜炎。除非拔除Tenckhoff导管，否则无法实现完全治愈。当拔除导管时，导管尖端培养物长出纯念珠菌属，且对导管切片的显微镜检查显示有大量酵母菌。尽管可能会有持续的个别报告称在不拔除导管的情况下成功根除了真菌性腹膜炎，但我们得出结论，在绝大多数情况下都需要拔除导管。
