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Published on: July 19, 2018
Fungal peritonitis in peritoneal dialysis: 5-year review from a North China center
Shouci Hu1, Ren Tong1, Yang Bo1
1Division of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300391, China.
Purpose:
Fungal peritonitis (FP) is a rare but devastating complication in peritoneal dialysis (PD), accounting for high rates of technique failure, morbidity and mortality. This study was conducted to investigate FPs with regard to peritonitis rate, microbiology testing, patient characteristics, clinical features, antifungal treatments, and clinical outcomes in patients on PD.
Methods:
This single-center study retrospectively reviewed all FP episodes diagnosed from June 1, 2012 to June, 2017. All FPs were matched in a 1:5 ratio with PD patients diagnosed with bacterial peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded.
Results:
Eleven fungal peritonitis episodes (rate of 0.0067 episodes per patient-year on dialysis) were identified. All FPs were caused by Candida species (identification and antifungal susceptibility testing were performed with VITEK 2® compact system), including C. albicans (6/11), C. parapsilosis (4/11) and C. krusei (1/11). Except C. krusei, no Candida resistance to fluconazole was detected. Compared to bacterial peritonitis (matched cases, n = 55), FP group showed higher rate of previous antibiotic use (p = 0.002), higher total effluent cell count (p = 0.007), and lower serum albumin (p = 0.01), higher rate of infection-related surgery (p < 0.001), HD transfer (p = 0.001), and all-cause death (p = 0.006). High prevalence (≥ 50%) of female gender, anuria, CCI ≥ 4, hypoalbuminemia, anemia, and hypokalemia were also observed in FP patients. More than half of the FP patients presented gastrointestinal symptoms (7/11) and extraperitoneal infection (6/11). Eight (72.7%) patients had catheter surgically removed with a median 5.5 lag days, four (36.4%) patients died within 3 months and six (54.5%) cases led to technique failure.
Conclusions:
FP results in high rates of catheter loss and all-cause mortality in 3 months of follow-up, candida species were the commonest pathogens in our center. Variations of clinical features and susceptibility patterns were observed. Gastrointestinal disorders maybe a potential risk factor for FP.
Insights
Fungal peritonitis (FP) in peritoneal dialysis (PD) patients leads to high rates of catheter loss and death within three months. Candida species are common culprits, and gastrointestinal issues may be a risk factor.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Fungal peritonitis (FP) is a severe complication of peritoneal dialysis (PD), often resulting in technique failure and increased mortality.
- Understanding FP's characteristics and outcomes is crucial for managing PD patients.
Purpose of the Study:
- To investigate the rate, microbiology, patient demographics, clinical features, treatments, and outcomes of fungal peritonitis in PD patients.
- To compare FP cases with bacterial peritonitis to identify distinct risk factors and clinical presentations.
Main Methods:
- A single-center retrospective study reviewed FP episodes from 2012 to 2017.
- FP cases were matched 1:5 with bacterial peritonitis cases for comparison.
- Clinical and biochemical data were collected for all peritonitis episodes.
Main Results:
- Eleven FP episodes caused by Candida species were identified, with Candida albicans being the most frequent.
- FP patients exhibited higher rates of prior antibiotic use, higher effluent cell counts, and lower serum albumin compared to bacterial peritonitis.
- Significant findings included higher rates of infection-related surgery, hemodialysis transfer, and all-cause mortality in the FP group.
Conclusions:
- Fungal peritonitis is associated with substantial rates of catheter loss and mortality within three months.
- Candida species are the primary pathogens, with variations in clinical features and antifungal susceptibility observed.
- Gastrointestinal disorders may represent a potential risk factor for developing fungal peritonitis in PD patients.
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