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Antifungal treatment of Candida peritonitis in continuous ambulatory peritoneal dialysis patients
Abstract:
Nine peritonitis episodes caused by Candida sp were diagnosed in eight continuous ambulatory peritoneal dialysis (CAPD) patients. Treatment with intraperitoneal administration of amphotericin B and 5-fluorocytosine while the peritoneal catheter was left in situ was effective in six episodes in five patients. Of the three other patients, two started again with CAPD after peritonitis had been cured, but one patient preferred to stay on hemodialysis. In four episodes, peritoneal white cell counts remained high during treatment despite negative cultures. This was probably the result of irritation of the peritoneal membrane caused by the antifungal treatment, possibly by amphotericin B. Persistently-elevated leukocyte counts during antifungal therapy, with or without signs and symptoms of peritonitis, are not necessarily an indication of treatment failure.
Insights
Antifungal treatment for Candida peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is effective, even with persistent high white cell counts. Elevated leukocytes during antifungal therapy do not always indicate treatment failure.
Area of Science:
- Nephrology
- Infectious Diseases
- Internal Medicine
Background:
- Peritonitis is a serious complication in continuous ambulatory peritoneal dialysis (CAPD).
- Candida species can cause peritonitis in CAPD patients, requiring specific antifungal treatment.
- The interpretation of white blood cell counts during treatment can be challenging.
Purpose of the Study:
- To evaluate the effectiveness of intraperitoneal antifungal therapy for Candida peritonitis in CAPD patients.
- To investigate the significance of persistently elevated peritoneal white cell counts during antifungal treatment.
Main Methods:
- Retrospective analysis of nine episodes of Candida peritonitis in eight CAPD patients.
- Treatment involved intraperitoneal amphotericin B and 5-fluorocytosine with the peritoneal catheter in situ.
- Monitoring of clinical symptoms, peritoneal fluid cultures, and white blood cell counts.
Main Results:
- Six out of nine peritonitis episodes were successfully treated with the antifungal regimen.
- Two patients resumed CAPD after recovery, while one opted for hemodialysis.
- Four episodes showed persistently high peritoneal white cell counts despite negative cultures, likely due to peritoneal membrane irritation from antifungal agents.
Conclusions:
- Intraperitoneal amphotericin B and 5-fluorocytosine is an effective treatment for Candida peritonitis in CAPD patients.
- Persistently elevated leukocyte counts during antifungal therapy do not necessarily signify treatment failure and may be due to drug-induced irritation.