[Clinical and microbiological aspects of fungal peritonitis in peritoneal dialysis]

Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and important mortality. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in the literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.