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Fungal peritonitis in patients on peritoneal dialysis: incidence, clinical features and prognosis
Abstract:
Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis. The incidence of infection per 100 patient-dialysis months was 0.36 for patients on intermittent peritoneal dialysis and 1.6 for patients on continuous ambulatory dialysis (p less than 0.005). Initial clinical findings included abdominal pain (76%), fever (59%), cloudy dialysate (76%) and poor dialysate outflow (6%). 15 patients received antibiotics within 4 weeks of developing peritonitis. All infections were caused by yeasts, with Candida parapsilosis and Candida albicans as the most common species. 14 patients were unable to continue peritoneal dialysis due to persistent or relapsing infection or the development of complications. 2 of the 3 patients who were able to continue peritoneal dialysis were treated with catheter replacement, intraperitoneal miconazole and oral ketoconazole.
Insights
Fungal peritonitis is more common in continuous ambulatory peritoneal dialysis patients. Most yeast infections, often Candida species, lead to patients stopping dialysis.
Area of Science:
- Nephrology
- Infectious Diseases
Background:
- Fungal peritonitis is a serious complication in patients undergoing chronic peritoneal dialysis.
- Yeast infections pose a significant risk to the continuity of peritoneal dialysis therapy.
Purpose of the Study:
- To investigate the incidence, clinical features, and outcomes of fungal peritonitis in patients on chronic peritoneal dialysis.
- To identify the causative fungal species and assess treatment strategies.
Main Methods:
- Retrospective analysis of 17 patients with fungal peritonitis on chronic peritoneal dialysis.
- Data collection included infection incidence, clinical presentation, causative organisms, and treatment outcomes.
Main Results:
- The incidence of fungal peritonitis was higher in continuous ambulatory peritoneal dialysis (1.6 per 100 patient-dialysis months) compared to intermittent peritoneal dialysis (0.36).
- Common symptoms included abdominal pain, fever, and cloudy dialysate. Candida species were the most frequent pathogens.
- 14 out of 17 patients discontinued peritoneal dialysis due to persistent infection or complications.
Conclusions:
- Fungal peritonitis, particularly in continuous ambulatory peritoneal dialysis, presents a challenge to maintaining dialysis therapy.
- Effective management, potentially involving antifungal agents and catheter interventions, is crucial for patient outcomes.