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Fungal peritonitis in children on peritoneal dialysis
Renske Raaijmakers1, Cornelis Schröder, Leo Monnens
1Pediatric Nephrology, Radboud University, Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands. r.raaijmakers@cukz.umcn.nl
Insights
Fungal peritonitis is a rare complication in children undergoing peritoneal dialysis (PD). Key risk factors include prior antibiotic use and previous gram-negative bacterial peritonitis, often leading to technique failure.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Fungal peritonitis is a serious complication in pediatric patients on peritoneal dialysis (PD).
- Understanding risk factors and effective treatments is crucial for managing this rare condition.
Purpose of the Study:
- To evaluate risk factors associated with fungal peritonitis in children on PD.
- To review therapeutic measures and outcomes for fungal peritonitis in this population.
Main Methods:
- A retrospective, multi-center study of 159 Dutch pediatric PD patients from 1980-2005.
- Analysis of 321 peritonitis episodes, focusing on 9 cases of fungal peritonitis.
- Evaluation of patient history, prior antibiotic use, and previous bacterial peritonitis rates.
Main Results:
- Fungal peritonitis occurred in 2.9% of peritonitis episodes, with Candida species being most common (78%).
- Prior antibiotic use (78%) and a higher rate of previous bacterial peritonitis (0.13 vs. 0.09 episodes/patient*month) were significant risk factors.
- PD catheter removal was necessary in all fungal peritonitis cases, with 4 patients successfully restarting PD.
Conclusions:
- Fungal peritonitis in pediatric PD patients is rare but associated with high technique failure rates.
- Key risk factors include high bacterial peritonitis rates, prior antibiotic exposure, and previous gram-negative bacterial peritonitis.
- Early PD catheter removal is recommended; peritoneal lavage with fluconazole before removal may improve outcomes and prevent technique failure.
Abstract:
Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.
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