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Fungal Peritonitis in Peritoneal Dialysis: An 18-year Experience from Nizwa Hospital, Sultanate of Oman
Jehad Al Laham1, Khalfan Alshaaili1, Hanaa M E Elsayed1
1Department of Nephrology, Nizwa Hospital, Nizwa, Oman.
Background:
Peritoneal dialysis is an effective therapy for end-stage kidney disease patients. Fungal peritonitis is a rare complication in patients on peritoneal dialysis. Data on peritoneal dialysis-associated fungal peritonitis from Oman are lacking.
Objective:
To report the epidemiology, management practices, and outcomes in cases of peritoneal dialysis-associated fungal peritonitis from a tertiary hospital in Oman.
Patients And Methods:
This retrospective study included all patients aged ≥13 years who developed fungal peritonitis after peritoneal dialysis treatment at Nizwa Hospital, Nizwa City, Oman, between March 01, 2005, and March 31, 2023.
Results:
A total of 311 patients were followed-up for peritoneal dialysis during the study period, of which 10 patients developed peritoneal dialysis-related fungal peritonitis (3.2%) (males: 80%; mean age: 54.5 ± 19.9 years). Candida spp. accounted for 80% of the cases, with a predominance of non-Candida albicans spp., while Aspergillus accounted for the remaining 20%. Previous bacterial peritonitis was noted in seven patients (70%) treated with multiple antibiotics, while six patients (60%) had received antibiotics within the past 1 month. Therapeutic approach was immediate systemic antifungal and peritoneal dialysis catheter removal with transfer to hemodialysis. The mortality rate was 20%.
Conclusions:
About 3% of the patients on peritoneal dialysis at Nizwa Hospital, Oman, developed fungal peritonitis. Prior antibiotic use was a major risk factor, and thus antifungal prophylaxis is recommended. Candida spp. was the most common pathogen.
Insights
Fungal peritonitis affects about 3% of peritoneal dialysis patients in Oman. Prior antibiotic use is a key risk factor, highlighting the need for antifungal prophylaxis to improve outcomes in end-stage kidney disease management.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Medicine
Background:
- Peritoneal dialysis is a vital treatment for end-stage kidney disease.
- Fungal peritonitis is a rare but serious complication in patients undergoing peritoneal dialysis.
- Limited data exists on fungal peritonitis in peritoneal dialysis patients in Oman.
Purpose of the Study:
- To investigate the epidemiology of peritoneal dialysis-associated fungal peritonitis.
- To analyze management strategies and patient outcomes.
- To provide insights into this complication in Oman.
Main Methods:
- A retrospective study was conducted at Nizwa Hospital, Oman.
- Included patients aged ≥13 years on peritoneal dialysis from March 2005 to March 2023.
- Analyzed data on demographics, causative agents, risk factors, treatment, and outcomes.
Main Results:
- 10 out of 311 (3.2%) peritoneal dialysis patients developed fungal peritonitis.
- Candida spp. (80%) were the most common pathogens, with non-Candida albicans predominance.
- Previous bacterial peritonitis and recent antibiotic use were significant risk factors (70% and 60%, respectively).
- Mortality rate was 20% despite antifungal treatment and catheter removal.
Conclusions:
- Fungal peritonitis incidence is approximately 3% in this Omani cohort.
- Prior antibiotic exposure is a critical risk factor.
- Antifungal prophylaxis is recommended to mitigate this risk and improve patient outcomes.
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