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Fungal peritonitis in continuous ambulatory peritoneal dialysis--the Auckland experience
R Nagappan1, J F Collins, W T Lee
1Department of Medicine, Auckland Hospital, New Zealand.
Abstract:
Fungal infection is an uncommon cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We report our center's experience with 38 episodes of fungal peritonitis occurring in 33 patients, out of a total of 503 patients managed on CAPD over 11 1/2 years, and review the relevant literature. Our usual management philosophy has been one of early peritoneal catheter removal without antifungal therapy. In those with worsening clinical features, and in those with persistence of signs and symptoms beyond 48 hours after catheter removal, antifungal drugs were administered. Only five patients received antifungal therapy initially, followed by later catheter removal. Seventy-six percent of patients treated by catheter removal alone (N = 21) and 64% of patients treated by catheter removal followed by antifungal therapy (N = 11) were successfully reestablished on CAPD. A policy of early catheter removal, usually alone, but followed by antifungal therapy in select cases, can be associated with a mortality rate of less than 15% and a high rate of return to effective peritoneal dialysis.
Insights
Fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rare. Early catheter removal, with or without antifungal drugs in select cases, effectively treats fungal peritonitis and allows high return to dialysis.
Area of Science:
- Nephrology
- Infectious Diseases
Background:
- Fungal peritonitis is an infrequent complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Managing fungal peritonitis requires specific treatment strategies to ensure patient recovery and continued dialysis.
Purpose of the Study:
- To report the experience of a single center with fungal peritonitis in CAPD patients.
- To evaluate the efficacy of early peritoneal catheter removal, with or without antifungal therapy, in managing fungal peritonitis.
Main Methods:
- Retrospective analysis of 38 episodes of fungal peritonitis in 33 CAPD patients over 11.5 years.
- Review of literature on fungal peritonitis management in CAPD patients.
- Comparison of outcomes between catheter removal alone versus catheter removal with antifungal therapy.
Main Results:
- Seventy-six percent of patients treated with catheter removal alone were successfully reestablished on CAPD.
- Sixty-four percent of patients treated with catheter removal followed by antifungal therapy were successfully reestablished on CAPD.
- A management policy of early catheter removal, with selective use of antifungal therapy, resulted in a mortality rate below 15%.
Conclusions:
- Early peritoneal catheter removal is a key strategy for treating fungal peritonitis in CAPD patients.
- Antifungal therapy may be beneficial in select cases of fungal peritonitis.
- This management approach facilitates a high rate of return to effective peritoneal dialysis.