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Fungal peritonitis in peritoneal dialysis: critical review of six cases
G Amici1, S Grandesso, A Mottola
1Nephrology and Dialysis Division, Regional Hospital, Treviso, Italy.
Abstract:
Fungal peritonitis (FP) is uncommon in patients on peritoneal dialysis (PD); it is difficult to treat and has a high mortality rate. We report 6 cases of fungal peritonitis observed between 1980 and 1992 in our center. The etiologic agents were: Candida spp., C. guilliermondi, C. parapsilosis, C. albicans, and Verticillium spp. All 6 patients had suffered at least one episode of bacterial peritonitis in the two months before the fungal infection appeared and were all treated by intraperitoneal administration of antibiotics. The catheter was removed early in 3 patients followed by antimycotic therapy, while the remaining 3 patients received antimycotic therapy, with removal of the catheter in a later stage. The result in the first group was that they all switched permanently to hemodialysis, while in the second group there were 2 deaths and 1 transfer to hemodialysis. In the light of these 6 cases, we analyzed 22 published reports to assess risk factors, therapy, and outcome of this pathology. The major predisposing factors were intraperitoneal antibiotics and bacterial peritonitis, and the best results were obtained by continuing PD plus intraperitoneal and systemic antifungal agents.
Insights
Fungal peritonitis (FP) is a rare but serious complication of peritoneal dialysis (PD). Early treatment with antifungal agents and catheter management are crucial for improving outcomes in PD patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Fungal peritonitis (FP) is an uncommon complication in patients undergoing peritoneal dialysis (PD).
- FP presents significant treatment challenges and is associated with high mortality rates.
- Predisposing factors include prior bacterial peritonitis and the use of intraperitoneal antibiotics.
Purpose of the Study:
- To report on six cases of fungal peritonitis in PD patients.
- To analyze risk factors, therapeutic strategies, and outcomes of FP.
- To evaluate the effectiveness of different management approaches for FP.
Main Methods:
- Retrospective case series of 6 PD patients with FP between 1980 and 1992.
- Review of 22 published reports on fungal peritonitis in PD patients.
- Comparison of outcomes based on early versus delayed catheter removal combined with antimycotic therapy.
Main Results:
- Candida spp. and Verticillium spp. were identified as causative agents.
- Patients treated with early catheter removal and antimycotics transitioned to hemodialysis.
- Patients treated with delayed catheter removal experienced higher mortality and transfer to hemodialysis.
Conclusions:
- Intraperitoneal antibiotics and bacterial peritonitis are significant risk factors for FP.
- Continuing PD with combined intraperitoneal and systemic antifungal therapy yielded the best outcomes.
- Prompt and appropriate management is essential for improving the prognosis of fungal peritonitis in PD patients.