Spontaneous fungal peritonitis: a severe complication in patients with advanced liver cirrhosis
Spontaneous fungal peritonitis: a severe complication in patients with advanced liver cirrhosis
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DOI：
10.1007/s10096-013-1953-2
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发表时间：
2014-02-01
影响因子：
4.5
通讯作者：
Lee, H. -S.
中科院分区：
文献类型：
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作者：
Hwang, S. Y.;Yu, S. J.;Lee, H. -S.
使用抗生素治疗肝硬化合并自发性腹膜炎患者有时会失败。真菌感染可能是此类患者抗生素治疗失败的原因之一。本研究探讨了自发性真菌性腹膜炎（SFP）的临床意义和特点。2000年至2005年在韩国首尔某三级保健中心连续治疗的肝硬化自发性腹膜炎患者被纳入研究。我们分析了SFP患者与自发性细菌性腹膜炎（SBP）患者的临床特点及预后。在研究期间，416例患者发生自发性腹膜炎，15例（3.6%）发生SFP。与收缩压患者相比，SFP患者院内性腹膜炎（住院时间为bbb72 h后发生的腹膜炎）发生率更高，Child-Pugh评分也更高（P < 0.01）。10例患者感染念珠菌（白色念珠菌8例，热带念珠菌1例，光秃念珠菌1例），5例感染新型隐球菌。11名患者同时感染了对抗生素敏感的细菌。只有5例患者使用了适当的抗真菌药物。SFP患者的1个月死亡率为73.3%(11 / 15；中位死亡时间为2天[范围，0-22])，显著高于单纯收缩压患者（28.7%,P = 0.0007）。SFP是肝硬化患者高死亡率的严重并发症。住院时间较长和Child-Pugh评分较高可能是风险因素。一旦在腹水中发现真菌，自发性腹膜炎患者应立即进行抗真菌治疗。
Treatment of cirrhotic patients with spontaneous peritonitis using antibiotics occasionally fails. Fungal infections may be one of the causes of antibiotic treatment failure in such patients. In this study we evaluated the clinical significance and characteristics of spontaneous fungal peritonitis (SFP). Consecutive cirrhotic patients with spontaneous peritonitis treated between 2000 and 2005 at a tertiary care center in Seoul, Korea, were included. We analyzed the clinical characteristics and the prognosis of SFP patients compared with patients with spontaneous bacterial peritonitis (SBP). During the study period 416 patients developed spontaneous peritonitis and 15 (3.6 %) had SFP. Compared with patients with SBP, nosocomial peritonitis (peritonitis that developed after hospitalization for > 72 h) was more common and the Child-Pugh score was higher in SFP patients (both, P < 0.01). Ten patients were infected with Candida spp. (C. albicans, 8; C. tropicalis, 1; C. glabrata, 1), and 5 with Cryptococcus neoformans. Eleven patients were co-infected with bacteria that were susceptible to the antibiotics administered. Only 5 patients were treated using appropriate anti-fungal agents. The 1-month mortality rate for SFP patients was 73.3 % (11 out of 15; median time to death, 2 days [range, 0-22]), which was significantly higher than patients with SBP alone (28.7 %, P = 0.0007). SFP is severe complication related to high mortality in cirrhotic patients. A longer admission and a higher Child-Pugh score may be risk factors. Immediate anti-fungal treatment is warranted in patients with spontaneous peritonitis, once fungus is found in the ascitic fluid.