[Fungal peritonitis episodes in a peritoneal dialysis centre during a 10-year period: a report of 11 cases]

Area of Science:

• Nephrology
• Infectious Diseases
• Mycology

Background:

• Fungal peritonitis is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD).
• It is associated with higher mortality and poorer outcomes compared to bacterial peritonitis.
• Predisposing factors and optimal treatment strategies remain incompletely defined.

Purpose of the Study:

• To retrospectively analyze the incidence, predisposing factors, treatment outcomes, and mortality associated with fungal peritonitis in CAPD patients.
• To identify risk factors for developing fungal peritonitis in this patient population.

Main Methods:

• Retrospective review of all diagnosed fungal peritonitis cases over a ten-year period in 218 CAPD patients.
• Analysis of patient demographics, clinical characteristics, treatment regimens, and outcomes.
• Identification of factors associated with fungal peritonitis development.

Main Results:

• Eleven episodes (4%) of fungal peritonitis occurred in 11 patients, all caused by Candida species.
• Mortality was 36%, and 55% of patients required a switch to long-term hemodialysis due to technique failure.
• Predisposing factors included recent antibiotic use, age over 70, low serum albumin, and prolonged CAPD duration.
• Treatment involved intraperitoneal fluconazole with oral 5-flucytosine; catheter removal was necessary if no improvement within 72 hours.

Conclusions:

• Fungal peritonitis in CAPD patients carries a significant risk of mortality and technique failure.
• Identifying and managing predisposing factors is crucial for improving patient outcomes.
• Prompt treatment with appropriate antifungal agents and consideration of catheter removal are essential.