Korean Journal of Nephrology 1993;12(4):666-673.

지속성 외래 복막투석 환자에서 진균성 복막염의 임상적 고찰 (Fungal Peritonitis in Parients with Continuous AMbulatory Peritoneal Dialysis)

조재용 , 김진안 , 박찬신 , 김김용 , 강신욱 , 강덕희 , 김흥수 , 최규헌 , 이호영 , 한대석 , 김유선 ( Jae Yong Cho , Jin Ahn Kim , Chan Shin Park , Ki Yong Kim , Shin Wook Kang , Duk Hee Kang , Heung Soo Kim , Kyu Hun Choi , Ho Yung Lee , Dae Suk Han , Yu S

Abstract

CAPD peritonitis is one of the most important com- lication of peritoneal dialysis. Among the CAPD peritonitis, fungal peritonitis is relatively rare but the prognosis is grave and removal of the peritoneal catheter is essential for management of peritonitis. We report our center's experience of 21 episodes of fungal peritonitis confirmed by CAPD effluent culture from January, 1983 to March 1993. The male to female ratio, the mean age, the mean duration of CAPD were 11:10, 48.2+11.2 years (range 17 -70), 21.0+20.8 monthes (1-72) respectively and the mean annual incidence of peritonitis was 1.47+1.49(0 -4). The most common causitive fungi were candida species with 869(N =18), and the remaining 3 cases were Trichosporon beigelii, Mucormycosis species, Cryptococcus neoformans isolated respectively. The severe complications of fungal peritonitis were intraaMominal abscess combined with intestinal obstruction in 3 cases, sepsis in 2 cases, meningitis in 1 case, and pneumonia in 1 case. Patients were treated by cathter removal alone (N = 5), by catheter removal followed by intravenous antifungal agent (N=13), or peritoneal catheter removal, antifungal agent and surgical drainage (N =3). Of these 60% 92% and 100% were treated successfully respectively. The complication and death rates were significantly low in the early peritoneal catheter removal group (within 7 days). And also, the group receiving antifungal agent more early showed better prognosis. In conclusion, we recommednd early peritoneal catheter removal, with antifungal medications as soon as fungal peritonitis is diagnosed in CAPD patients. And if symptoms of intestinal obstruction or abdominal pain continue despite adequate treatment, complication such as intraabdominal abscess should be suspected.