Fungal peritonitis in pediatric patients

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Although treatment with fluconazole (FCZ) has improved catheter survival and preservation of the peritoneal membrane, FP still carries a high morbidity and mortality in pediatrics. High-risk factors for FP include previous usage of systemic antibiotics and recurrent bacterial peritonitis. A prospective experience in the treatment of FP was conducted at the University of Miami/Jackson Children's Hospital from 1992 to 1997. All patients received either oral or intravenous loading dose of FCZ (5-7 mg/kg) followed by intraperitoneal (i.p.) FCZ (75 mg/L). Amphotericin B (amp B) was added when clinical sepsis was present. A total of 6 patients had FP (all Candida sp.; mean age: 6 years). Two of these patients were neonates with Tenckhoff-catheter placement at less than 1 week of age. Five patients achieved sterilization of the peritoneal fluid. One patient required catheter removal (C. tropicalis). The 2 neonates were infection free for 29 and 41 days, respectively, but both died of superimposed bacterial sepsis. The remaining 4 patients survived and completed 6 weeks of FCZ treatment. Two have had preservation of the peritoneal membrane for more than 1 year. The other 2 were switched to hemodialysis. We conclude that FCZ is an effective treatment for fungal peritonitis in pediatric patients. Adjunct therapy with amp B is usually necessary if sepsis is present. Although eradication of the fungus is possible in a majority of cases, neonates and immunocompromised hosts remain at high risk for morbidity and mortality.