Risk Factors of Developing Subsequent Fungal Peritonitis in Patients with Peritoneal Dialysis-Related Bacterial Peritonitis

腹膜透析相關細菌性腹膜炎患者發生續發性黴菌性腹膜炎的危險因子

周哲毅(Che-Yi Chou) ； 高銘聰(Min-Tsung Kao) ； 黃秋錦(Chiu-Ching Huang)

《Acta Nephrologica》 20卷2期 (2006/04) Pp. 105-108

摘要

背景：黴菌性腹膜炎是腹膜透析病患，一嚴重但少見的併發症，在文獻中細菌性腹膜炎和先前抗生素之使用是發生黴菌性腹膜炎的危險因子，但其他的危險因子文獻上卻少見報告。
背景：研究細菌性腹膜炎後之續發黴菌性腹膜炎的危險因子。
方法：從2001年1月到2004年7月，我們回溯研究在本院腹膜透析中心接受治療的93位患者，發生145次的細菌性腹膜炎，包含：革蘭氏陽性和陰性菌。在六個月的追蹤期間內發生17次的黴菌性腹膜炎。記錄可能的危險因子，包含：性別、年齡、接受腹膜透析的時間、原發疾病、便秘、血色素和血清白蛋白值。以獨立樣本T檢定來進行比較；顯著的因子，再以多變項邏輯迴歸方法分析其對發生黴菌性腹膜炎的影響。
結果：續發黴菌性腹膜炎的預後極差，70.6%的研究病人需要拔管，死亡率高達29.4%；其中只有兩位病人能成功治癒，而繼續接受腹膜透析。我們發現革蘭氏陰性菌腹膜炎（特別是綠膿桿菌）及無便秘病史的病人，有較高的機會發生續發黴菌性腹膜炎(p=0.001 & 0.002)。
結論：細菌性腹膜炎後之續發黴菌腹膜炎的預後極差，而革蘭氏陰性菌及沒有便秘的病人有較高的發生率。

關鍵字

腹膜透析 ； 細菌性腹膜炎 ； 黴菌性腹膜炎 ； 便秘

並列摘要

Background. Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (PD). Previous antibiotics exposure and bacterial infections are potential risk factors. To identify the possible risk factors of developing subsequent fungal peritonitis after episodes of bacterial peritonitis, patients with PD-related bacterial peritonitis were followed up for six months, and we recorded the episodes of subsequent fungal peritonitis.
Methods. The baseline patients' characteristics included gender, age, duration of PD, underlying disease, history of constipation, hematocrit, serum albumin, catheter removal, and death related to FP were recorded and analyzed with independent T test and Chi-square test. The parameters with significant differences were further analyzed by multivariate logistic regression.
Results. From January 1, 2001 to July 31, 2004, 145 episodes of bacterial peritonitis occurred in 93 PD patients. Seventeen episodes of subsequent FP were identified during six months' follow-up. The outcome of subsequent FP was poor, a 70.6% catheter removal rate and a 29.4% mortality rate were noted. Only two patients were treated successfully and still kept on PD. The risk factors of developing subsequent FP were bacterial peritonitis caused by Gram-negative pathogen and patients without a history of constipation (p=0.001 and 0.002).
Conclusions. In PD patients, the outcome of subsequent FP after bacterial peritonitis is poor. Peritonitis caused by Gram-negative pathogen (esp. Pseudomonas aeruginosa) and patients without a history of constipation are at risk of developing FP.

並列關鍵字

constipation ； gram-positive peritonitis ； gram-negative peritonitis ； fungal peritonitis