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Non Candida albicans fungal peritonitis in continuous ambulatory peritoneal dialysis patients
1Tulane University Health Sciences Center, Section of Nephrology, New Orleans, Louisiana, USA.
Abstract:
We report four episodes of non Candida albicans peritonitis (NCAP) in 3 patients on continuous ambulatory peritoneal dialysis (CAPD). Risk factors for NCAP included diabetes mellitus and prior antibiotic use in half of the cases. The antibiotic treatment was prescribed for exit-site infection (ESI) or peritonitis in the patient. Treatment for NCAP included antifungal therapy with oral fluconazole or intravenous amphotericin B. The NCAP resulted in catheter loss in 100% of the patients over time. Initial catheter salvage in one patient was followed 6 months later by catheter loss following treatment of a bacterial peritonitis that was complicated by the development of Candida (Torulopsis) glabrata peritonitis unresponsive to treatment with intravenous amphotericin B. Although the literature suggests that Candida peritonitis responds to oral fluconazole with and without catheter removal, this series suggests that the treatment of NCAP includes removal of the peritoneal dialysis catheter with appropriate antifungal agents.
Insights
Non-Candida albicans peritonitis (NCAP) in continuous ambulatory peritoneal dialysis (CAPD) patients often leads to catheter loss. Treatment requires antifungal agents and peritoneal dialysis catheter removal for better outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication of CAPD, with Candida species being a potential cause.
- Non-Candida albicans peritonitis (NCAP) presents unique challenges in management.
Observation:
- Four episodes of NCAP occurred in three CAPD patients.
- Identified risk factors included diabetes mellitus and prior antibiotic use for exit-site infection or peritonitis.
- Patients received antifungal therapy with fluconazole or amphotericin B.
Findings:
- All NCAP cases resulted in eventual peritoneal dialysis catheter loss.
- One patient experienced catheter loss six months after initial salvage due to refractory Candida (Torulopsis) glabrata peritonitis.
- Standard antifungal treatments showed limited success, highlighting treatment complexities.
Implications:
- This study suggests that NCAP management in CAPD patients necessitates peritoneal dialysis catheter removal.
- Aggressive antifungal therapy in conjunction with catheter removal may improve patient outcomes.
- Further research is needed to establish optimal treatment protocols for NCAP in CAPD.
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