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Candida parapsilosis peritonitis in patients on CAPD
1Department of Medicine, Hatyai Hospital, Songkhla, Thailand. kcharocn@health2.moph.go.th
Mycopathologia
|September 11, 2002
Summary
Candida parapsilosis peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients often requires catheter removal for effective treatment. Antifungal therapy alone is frequently insufficient, impacting long-term dialysis program continuation.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Fungal peritonitis, particularly from Candida parapsilosis, is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective management strategies for C. parapsilosis peritonitis in CAPD patients are crucial to preserve dialysis access and patient outcomes.
Purpose of the Study:
- To review clinical manifestations, treatment outcomes, and factors associated with CAPD program discontinuation in patients with C. parapsilosis peritonitis.
Main Methods:
- Retrospective review of 24 episodes of C. parapsilosis peritonitis in 23 CAPD patients over a 6-year period.
- Analysis of clinical data, laboratory findings, treatment regimens (including amphotericin B and catheter management), and patient outcomes.
Main Results:
- Clinical and laboratory findings were similar to other peritonitis pathogens.
- Intravenous amphotericin B was initiated in all cases; catheter removal was necessary in 6 cases.
- Antifungal treatment alone was ineffective in most cases; 15 episodes (62.5%) continued CAPD.
- CAPD discontinuation occurred in 9 cases due to death, patient preference, or abdominal adhesions.
- Peritonitis following gram-negative bacterial peritonitis and fluconazole use post-catheter removal were linked to CAPD discontinuation.
Conclusions:
- Rapid catheter removal is recommended for C. parapsilosis peritonitis in CAPD patients, especially those with a history of gram-negative peritonitis.
- Management should focus on timely intervention, often involving catheter removal, rather than solely relying on antifungal therapy to ensure successful CAPD program continuation.