This paper is a report of a 34-year-old man with chronic renal failure undergoing Continuous Ambulatory Peritoneal Dialysis which developed peritonitis due to Geotricum candidum. The diagnosis was established by cultu...This paper is a report of a 34-year-old man with chronic renal failure undergoing Continuous Ambulatory Peritoneal Dialysis which developed peritonitis due to Geotricum candidum. The diagnosis was established by culture of dialysis fluid. The purpose of this report is to provide data on a fungal peritonitis due to a non-common agent.展开更多
Fungal peritonitis (FP) is a serious infectious complication of peritoneal dialysis (PD). This retrospective study was conducted in 11 cases of FP a-mong 64 cases of patients with bacterial peritonitis (BP). Our resul...Fungal peritonitis (FP) is a serious infectious complication of peritoneal dialysis (PD). This retrospective study was conducted in 11 cases of FP a-mong 64 cases of patients with bacterial peritonitis (BP). Our results showed that age and sex underlying disease did not correlate significantly with the development of FP (P>0. 05),while long-term, repeated administration of antibiotics did (P<0. 01). It is suggested that the patients recently suffering from BP and being re-sistant to antibiotics were at great risk of suffering from FP. The key to preventFP was to avoid BP, to use sensitive antibiotics with appropriate courses and to give nutritive treatment.展开更多
Spontaneous bacterial(SBP) and spontaneous fungal peritonitis(SFP) can be a life-threatening infection in patients with liver cirrhosis(LC) and ascites. One of the possible mechanisms of developing SBP is bacterial tr...Spontaneous bacterial(SBP) and spontaneous fungal peritonitis(SFP) can be a life-threatening infection in patients with liver cirrhosis(LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant(MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.展开更多
Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to...Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.展开更多
BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhos...BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL. AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6- mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study. RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%- 25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%. CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and th展开更多
BACKGROUND Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites.Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recogni...BACKGROUND Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites.Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recognized but devastating complication in end-stage cirrhosis.Although high mortality was previously noted,scant data are available to fully define the factors responsible for the occurrence of SFP and its mortality.AIM To illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for the occurrence of SFP and its short-term mortality.METHODS We performed a matched case-control study between January 1,2007 and December 30,2018.Patients with SFP were included in a case group.Sex-,age-,and time-matched patients with SBP were included in a control group and were further divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture).The clinical features and laboratory parameters,severity models,and prognosis were compared between the case and control groups.Logistic regression analysis was used to determine the risk factors for occurrence,and the Cox regression model was used to identify the predictive factors for short-term mortality of SFP.RESULTS Patients with SFP exhibited more severe systemic inflammation,higher ascites albumin and polymorphonuclear neutrophils,and a worsened 15-d mortality than patients in the control groups.Antibiotic administration (case vs control-1: OR = 1.063,95%CI: 1.012-1.115,P = 0.014;case vs control-2: OR = 1.054,95%CI: 1.014-1.095,P = 0.008) remarkably increased the occurrence of SFP or fungiascites.Hepatorenal syndrome (HR = 5.328,95%CI: 1.050-18.900) and total bilirubin (μmol/L;HR = 1.005,95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.CONCLUSION Long-term antibiotic administration increases the incidence of SFP,and hepatorenal syndrome and total bilirubin are closely related to short-term mortality.展开更多
文摘This paper is a report of a 34-year-old man with chronic renal failure undergoing Continuous Ambulatory Peritoneal Dialysis which developed peritonitis due to Geotricum candidum. The diagnosis was established by culture of dialysis fluid. The purpose of this report is to provide data on a fungal peritonitis due to a non-common agent.
文摘Fungal peritonitis (FP) is a serious infectious complication of peritoneal dialysis (PD). This retrospective study was conducted in 11 cases of FP a-mong 64 cases of patients with bacterial peritonitis (BP). Our results showed that age and sex underlying disease did not correlate significantly with the development of FP (P>0. 05),while long-term, repeated administration of antibiotics did (P<0. 01). It is suggested that the patients recently suffering from BP and being re-sistant to antibiotics were at great risk of suffering from FP. The key to preventFP was to avoid BP, to use sensitive antibiotics with appropriate courses and to give nutritive treatment.
文摘Spontaneous bacterial(SBP) and spontaneous fungal peritonitis(SFP) can be a life-threatening infection in patients with liver cirrhosis(LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant(MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.
文摘Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.
文摘BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL. AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6- mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study. RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%- 25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%. CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and th
文摘BACKGROUND Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites.Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recognized but devastating complication in end-stage cirrhosis.Although high mortality was previously noted,scant data are available to fully define the factors responsible for the occurrence of SFP and its mortality.AIM To illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for the occurrence of SFP and its short-term mortality.METHODS We performed a matched case-control study between January 1,2007 and December 30,2018.Patients with SFP were included in a case group.Sex-,age-,and time-matched patients with SBP were included in a control group and were further divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture).The clinical features and laboratory parameters,severity models,and prognosis were compared between the case and control groups.Logistic regression analysis was used to determine the risk factors for occurrence,and the Cox regression model was used to identify the predictive factors for short-term mortality of SFP.RESULTS Patients with SFP exhibited more severe systemic inflammation,higher ascites albumin and polymorphonuclear neutrophils,and a worsened 15-d mortality than patients in the control groups.Antibiotic administration (case vs control-1: OR = 1.063,95%CI: 1.012-1.115,P = 0.014;case vs control-2: OR = 1.054,95%CI: 1.014-1.095,P = 0.008) remarkably increased the occurrence of SFP or fungiascites.Hepatorenal syndrome (HR = 5.328,95%CI: 1.050-18.900) and total bilirubin (μmol/L;HR = 1.005,95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.CONCLUSION Long-term antibiotic administration increases the incidence of SFP,and hepatorenal syndrome and total bilirubin are closely related to short-term mortality.
