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Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis: a national experience
Nakysa Hooman1, Abbas Madani, Mostafa Sharifian Dorcheh
1Division of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran. nakisa45@yahoo.com
Insights
Fungal peritonitis (FP) is a serious complication in children on peritoneal dialysis. Preventing bacterial peritonitis and early catheter removal can reduce FP
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Fungal peritonitis (FP) is a rare but severe complication of peritoneal dialysis (PD).
- FP can lead to catheter obstruction, dialysis failure, and peritoneal dysfunction in pediatric patients.
- This study investigates the incidence and risk factors of FP in children undergoing PD.
Purpose of the Study:
- To evaluate the frequency of fungal peritonitis in children on peritoneal dialysis.
- To identify clinical and demographic risk factors associated with fungal peritonitis in this population.
Main Methods:
- A retrospective multicenter study was conducted across 5 pediatric PD centers in Iran (1971-2006).
- Data from 93 children with 155 peritonitis episodes were reviewed.
- Risk ratios were calculated to determine FP risk factors.
Main Results:
- Out of 155 peritonitis episodes, 16 were fungal, exclusively Candida albicans.
- Relapsing bacterial peritonitis (P = .009) and prior antibiotic use were associated with increased FP risk.
- Catheter removal was necessary in all cases; 6/12 patients experienced catheter obstruction and peritoneal dysfunction, and 5 died.
Conclusions:
- Fungal peritonitis in children carries high morbidity and mortality.
- Preventing bacterial peritonitis is crucial for reducing FP incidence.
- Early recognition and catheter removal are recommended for managing FP.
Introduction:
Fungal peritonitis (FP), causing catheter obstruction, dialysis failure, and peritoneal dysfunction, is a rare but serious complication of peritoneal dialysis. In this study, the frequency and risk factors of FP are evaluated in children who underwent peritoneal dialysis.
Materials And Methods:
A retrospective multicenter study was performed at the 5 pediatric peritoneal dialysis centers in Iran from 1971 to 2006, and FP episodes among 93 children were reviewed. Risk ratios were calculated for the clinical and demographic variables to determine the risk factors of FP.
Results:
Ninety-three children aged 39 months on average were included in study. Sixteen out of 155 episodes of peritonitis were fungi infections, all by Candida albicans. The risk of FP was higher in those with relapsing bacterial peritonitis (P = .009). Also, all of the patients had received antibiotics within the 1 month prior to the development of FP. Catheters were removed in all patients after 1 to 7 days of developing FP. Six out of 12 patients had catheter obstruction and peritoneal loss after the treatment and 5 died due to infection.
Conclusions:
Fungal peritonitis, accompanied by high morbidity and mortality in children should be reduced by prevention of bacterial peritonitis. Early removal of catheter after recognition of FP should be considered.
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