Fungal peritonitis in peritoneal dialysis patients

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Microbiology

Background:

• Peritonitis is a frequent complication of peritoneal dialysis (PD), with fungal infections accounting for 1%-15% of cases.
• Fungal peritonitis (FP) carries significant mortality (5%-53%) and risk of PD technique failure (up to 40%).
• Candida species are the primary cause of FP, with a potential shift from Candida albicans to non-albicans species and increasing reports of unusual fungi.

Purpose of the Study:

• To review the epidemiology, clinical features, diagnosis, and management of fungal peritonitis in patients undergoing peritoneal dialysis.
• To highlight the challenges in diagnosing FP and the potential of new molecular techniques.
• To identify risk factors for mortality and technique failure and discuss prophylactic and therapeutic strategies.

Main Methods:

• Review of existing literature on fungal peritonitis in peritoneal dialysis.
• Analysis of clinical features, diagnostic methods, and treatment outcomes.
• Discussion of risk factors, prophylaxis, and management guidelines.

Main Results:

• Clinical presentation of FP often mimics bacterial peritonitis, complicating early diagnosis.
• Traditional phenotypic identification methods are slow; molecular techniques like PCR show promise for faster diagnosis.
• Abdominal pain, fever, and retained catheters are risk factors for adverse outcomes in FP.
• Nystatin prophylaxis may be considered in high-FP incidence programs.
• Immediate catheter removal upon fungal identification is recommended, followed by 10-14 days of antifungal therapy post-removal.

Conclusions:

• Fungal peritonitis is a severe complication of PD requiring prompt diagnosis and management.
• Catheter removal and appropriate antifungal therapy are key to successful treatment and PD recovery.
• Individual PD programs should assess their FP rates to determine the need for prophylactic measures.