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Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre
Mohammed Alsuhaibani1,2, Egab Aldosari3, Khawla A Rahim4
1Department of Paediatrics, College of Medicine, Qassim University, P.O. Box 6666, Buraidah, Qassim, 51452, Saudi Arabia. msuhaibani@qumed.edu.sa.
Insights
Fungal peritonitis (FP) in children on peritoneal dialysis (PD) is linked to congenital/infantile nephrotic syndrome and young age. Early diagnosis and management are crucial to prevent serious complications like peritoneal membrane failure.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Fungal peritonitis (FP) is a rare but severe complication in pediatric patients undergoing peritoneal dialysis (PD).
- Understanding risk factors and outcomes is vital for managing FP in this vulnerable population.
Purpose of the Study:
- To investigate risk factors, clinical features, causative agents, antifungal susceptibility, and outcomes of FP in children in Saudi Arabia.
- To identify specific patient groups at higher risk for FP during PD.
Main Methods:
- A case-control study analyzing medical records of pediatric PD patients (0-14 years) from 2007-2017.
- FP episodes were matched with bacterial peritonitis episodes at a 1:4 ratio for comparison.
Main Results:
- FP accounted for 5.6% of 194 peritonitis episodes, with Candida species being the most common cause (82%).
- Patients with FP showed a higher incidence of congenital/infantile nephrotic syndrome and were younger than 5 years.
- Catheter removal rates were higher in FP cases, with one mortality despite intervention; 75% of Candida isolates were fluconazole-susceptible.
Conclusions:
- FP poses a significant risk of peritoneal membrane failure in pediatric PD patients.
- Congenital/infantile nephrotic syndrome and young age (<5 years) are identified as key risk factors for FP.
- Prompt diagnosis and management are essential for improving outcomes in pediatric FP.
Background:
Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia.
Methods:
In this case-control study, the medical records and laboratory results of paediatric patients aged 0-14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio).
Results:
A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole.
Conclusions:
This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.
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