Seeking Clarity within Cloudy Effluents Differentiating Fungal from Bacterial Peritonitis in Peritoneal Dialysis Patients 英文参考文献.docVIP

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Seeking Clarity within Cloudy Effluents Differentiating Fungal from Bacterial Peritonitis in Peritoneal Dialysis Patients 英文参考文献.doc

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Seeking Clarity within Cloudy Effluents Differentiating Fungal from Bacterial Peritonitis in Peritoneal Dialysis Patients 英文参考文献

SeekingClaritywithinCloudyEffluents:Differentiating FungalfromBacterialPeritonitisinPeritonealDialysis Patients RuchirChavada1,JenKok2,SebastiaanvanHal1,SharonC-A.Chen2* 1DepartmentofMicrobiologyandInfectiousDiseases,SydneySouthWestPathologyService,LiverpoolHospital,Liverpool,Australia,2CentreforInfectiousDiseasesand MicrobiologyLaboratoryServices,InstituteofClinicalPathologyandMedicalResearch,WestmeadHospital,Westmead,Australia Abstract Background: Fungalperitonitisisaseriouscomplicationofperitonealdialysis(PD)therapywiththemajorityofpatients ceasingPDpermanently.Theaimsofthisstudyweretoidentifyriskfactorsandclinicalassociationsthatmaydiscriminate betweenfungalfrombacterialperitonitis. Methods: We retrospectively identified episodes of fungal peritonitis from 2001–2010 in PD patients at Liverpool and WestmeadHospitals(Australia).Fungalperitonitiscaseswerematchedina1:2ratiowithpatientswithbacterialperitonitis fromeachinstitution’sdialysisregistry,occurringclosestintimetothefungalepisode.Patientdemographic,clinicaland outcomedatawereobtainedfromthemedicalrecords. Results:Thirty-nineepisodesoffungalperitonitis(rateof0.02episodesperpatient-yearofdialysis)werematchedwith78 episodes of bacterial peritonitis. Candida species were the commonest pathogens (35/39; 90% episodes) with Candida albicans(37%),Candidaparapsilosis(32%)andCandidaglabrata(13%)themostfrequentlyisolatedspecies.Comparedto bacterial peritonitis, fungal peritonitis patients had received PD for significantly longer (1133 vs. 775 catheter-days; p=0.016), were more likely to have had previous episodes of bacterial peritonitis (51% vs. 10%; p=0.01), and to have receivedpriorantibacterialtherapy(51%vs.10%;p=0.01).Patientswithfungalperitonitiswerelesslikelytohavefeverand abdominal pain on presentation, but had higher rates of PD catheter removal (79% vs. 22%; p,0.005), and permanent transfertohaemodialysis(87%vs.24%;p,0.005).Hospitallengthofstaywassignificantlylongerinpatientswithfungal peritonitis(26.1daysv