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Fungal peritonitis during continuous ambulatory peritoneal dialysis: a report of 17 cases
1Department of Medicine, University of Mississippi Medical Center, Jackson.
Abstract:
Seventeen cases of fungal peritonitis and one case of Nocardia asteroides peritonitis were observed in 141 patients during the first 5 years of our continuous ambulatory peritoneal dialysis program (CAPD). Fungal peritonitis accounted for 7% of the episodes of peritonitis observed in this interval. There were eight deaths associated with fungal peritonitis. In only three instances could factors predisposing to fungal peritonitis be identified. We were unable to predict who would develop fungal peritonitis by analysis of nutritional, demographic, or technical factors associated with the dialysis procedure. The diagnosis of fungal peritonitis was easily established using routine blood agar culture techniques. Successful management of these patients included prompt removal of the Tenckhoff catheter and intravenous (IV) administration of amphotericin.
Insights
Fungal peritonitis is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), causing significant mortality. Early diagnosis and treatment, including catheter removal and amphotericin, are crucial for successful management of this infection.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Microbiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a significant complication of CAPD, with fungal infections posing a particular challenge.
- Fungal peritonitis can lead to high mortality rates if not managed promptly.
Purpose of the Study:
- To report the incidence and outcomes of fungal peritonitis in patients undergoing CAPD.
- To identify predisposing factors and assess diagnostic and management strategies for fungal peritonitis.
- To evaluate the effectiveness of Tenckhoff catheter removal and amphotericin therapy.
Main Methods:
- Retrospective analysis of 141 patients in a CAPD program over 5 years.
- Identification of fungal peritonitis cases through routine blood agar cultures.
- Review of patient data for nutritional, demographic, and technical factors.
- Assessment of treatment outcomes, including mortality and management protocols.
Main Results:
- Seventeen cases of fungal peritonitis (7% of all peritonitis episodes) and one case of Nocardia asteroides peritonitis were identified.
- Eight deaths were associated with fungal peritonitis.
- Predisposing factors were identified in only three cases, and predictive factors were not found.
- Diagnosis was readily achieved using standard culture techniques.
- Successful management involved Tenckhoff catheter removal and intravenous amphotericin.
Conclusions:
- Fungal peritonitis is a severe complication of CAPD with a high mortality rate.
- Predicting or preventing fungal peritonitis based on patient or procedural factors remains difficult.
- Prompt diagnosis via routine cultures and aggressive treatment, including catheter removal and amphotericin, are essential for patient survival.