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Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: a single centre Indian experience
K N Prasad1, N Prasad, A Gupta
1Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India. knprasad@sgpgi.ac.in
Background:
Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We reviewed our FP cases to analyse the causative agents and possible risk factors in relation to FP and its outcome and mortality.
Methods:
Records of all FP cases were reviewed. FP was diagnosed based on effluent cell count and positive fungal culture in suitable media.
Results:
Between October 1993 and November 2001, 261 patients underwent CAPD. FP was detected in 28 patients, one episode in each patient (14.3% of the total peritonitis episodes). Candida species and dematiaceous fungi+/-Candida species were responsible for 89.3 and 10.7% of episodes, respectively. Patients with preceding bacterial peritonitis (BP) developed FP more frequently (25.6%) than de novo cases (2.9%) (P<0.0001) and lower proportion of them continued CAPD (8.6% vs. 60%; P=0.007). Mortality in patients having abdominal pain with and without fever, and catheter in situ was significantly higher than in those patients who did not have these risk factors (9/11 vs. 6/17, P=0.01; 13/17 vs. 2/11, P=0.003; 6/6, vs. 9/22, P=0.01, respectively).
Conclusions:
Higher proportion of our patients had FP; preceding BP was a significant risk factor for development of FP and technique failure. Abdominal pain+/-fever in patients and catheter in situ were identified as risk factors associated with mortality.
Insights
Fungal peritonitis (FP) is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Preceding bacterial peritonitis (BP) increases FP risk and technique failure, while abdominal pain, fever, and catheter presence are linked to mortality.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Medicine
Background:
- Fungal peritonitis (FP) is a significant complication for patients on continuous ambulatory peritoneal dialysis (CAPD).
- Understanding causative agents and risk factors is crucial for managing FP and improving patient outcomes.
Purpose of the Study:
- To analyze causative agents of fungal peritonitis in CAPD patients.
- To identify risk factors associated with FP development, technique failure, and mortality.
Main Methods:
- Retrospective review of fungal peritonitis cases in CAPD patients.
- Diagnosis confirmed by effluent cell count and positive fungal cultures.
- Analysis of patient records to identify risk factors and outcomes.
Main Results:
- Fungal peritonitis occurred in 14.3% of peritonitis episodes, with Candida species being the most common agent.
- Patients with preceding bacterial peritonitis (BP) had a significantly higher incidence of FP (25.6% vs. 2.9%) and lower CAPD continuation rates.
- Mortality was significantly higher in patients presenting with abdominal pain, fever, and an in-situ catheter.
Conclusions:
- A higher proportion of CAPD patients experienced FP in this cohort.
- Preceding bacterial peritonitis is a significant risk factor for developing fungal peritonitis and subsequent technique failure.
- Abdominal pain, fever, and catheter presence are identified as risk factors associated with increased mortality in CAPD patients with FP.
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