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題 名 | Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis=長期腹膜透析病患感染徽菌腹膜炎之研究 |
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作 者 | 陳建良; 方華章; 周康茹; 鍾孝民; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 14:3 2000.09[民89.09] |
頁 次 | 頁107-112+134 |
分類號 | 415.816 |
關鍵詞 | 連續可活動性腹膜透析; 徽菌腹膜炎; Continuous ambulatory peritoneal dialysis; Fungal peritonitis; |
語 文 | 英文(English) |
中文摘要 | 本研究目的在分析慢性腎衰竭病人在長期進行腹膜透析治療後,感染到鰴菌腹膜炎的病人之微生物與臨床特性。診斷鰴菌腹膜炎主要依賴三個徵兆:第一是腹痛不適,第二是透析液變渾濁且之中白血球數增加,第三是兩次及兩認以上透析液染色或培養出病原。自1991年到2001年,本院110例的腹膜炎中有七例是鰴菌腹膜炎,佔總數的6.4%。此七位鰴菌腹膜炎病患中有四位曾罹患細菌性腹膜炎。其中一位病患因腸穿孔死於鰴菌合併細菌性腹膜炎併敗血症。三位病患感染念珠菌,丙位感染表皮生孢子菌,另兩位則是感染青鰴菌。所有病患在經過治療後,只有一位日後仍持續進行腹膜透析治療,其他則改採血液透析治療。我們在處理本院的鰴菌腹膜炎病例時,發現病患最常感染酵母菌:如念珠菌、生孢子菌;而節狀菌絲的鰴菌則以青鰴菌最常見。針對五位酵母菌感染患者,吾人採用fluconazole腹腔注射及管內浸泡amphot-ericin B來治療其中三位,希望能避免拔除腹膜透析管,但因為腹膜炎症狀無法緩解最終三位病患仍需全部拔除腹膜導管才能解決問題。總之,鰴菌腹膜炎雖不是長期腹膜透析病患常見之併發病,但常會造成病人死亡或無法繼續進行腹膜透析治療。我們建議當確定鰴菌腹膜炎症時,最好及早拔除腹膜透析管,同時我們發現併用腹腔注射fluconazole及管內浸泡amphot-ericin B並不能根治鰴菌腹膜炎。 |
英文摘要 | The purpose of this study was to analyze the microbiological and clinical features of fungal peritonitis in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (CAPD). The diagnosis of peritonitis was based on the presence of abdominal pain or discomfort, cloudy peritoneal effluent with an elevated ascetic leukocyte count and repeatedly positive smear or positive culture of fungi from the peritoneal effluent. From 1991 to 2001, there were seven episodes of fungal peritonitis, comprising 6.4% (7/110) of all episodes of peritonitis in our dialysis center. The isolated fungi were as follows: Candida spp. in three cases, Trichosporon cutaneum in two cases and Penicillium spp. in two cases. In four cases, bacterial infection was documented before the fungal peritonitis. One patient with secondary peritonitis due to intestinal perforation died of fulminant sepsis. All but one patient were shifted to hemodialysis. It was concluded that although fungal peritonitis wa a rare complication of CAPD-related peritonitis, the rate of morbidity and dropout from the CAPD profram were high. The most frequently isolated fungi were Candida spp. and the most frequently isolated mold was Penicillium. A new regimen using intracatheter amphotericin B retention and oral or intra-peritoneal fluconazole was administered to treat the fungal peritonitis and attempt salvage of the catheter. However, all catheters had to be removed due to persistent symptoms and repeatedly positive culture for fungi. We suggest that early catheter removal is probably necessary for fungal peritonitis. |
本系統中英文摘要資訊取自各篇刊載內容。