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Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes
S J Goldie1, L Kiernan-Tridle, C Torres
1Department of Internal Medicine, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT 06511, USA.
Abstract:
Fungal peritonitis (FP) is a rare but serious complication of chronic peritoneal dialysis (CPD) therapy and is associated with high morbidity and CPD drop-out. Risk factors and management of FP remain controversial. We reviewed our experience with FP in an attempt to identify risk factors and to examine outcome in relation to treatment strategies. Between March 1984 and August 1994, 704 patients were maintained on CPD therapy in our unit. A total of 1,712 episodes of peritonitis were identified among these patients. Fungal peritonitis accounted for 55 (3.2%) of these episodes. The patients on CPD therapy who developed FP were similar to those who did not develop FP with regard to age, gender, underlying etiology for end-stage renal disease, and comorbid disease. Prior antibiotic use was noted in 87.3% of episodes of FP. The peritonitis rate in the patients who developed FP was one episode every 5.1 months compared with one episode every 9.9 patient-months in the CPD patients who did not develop this infection. Candida sp caused 74.5% of the episodes of FP. All patients were treated with antifungal drugs. In 85.5% of infections the Tenckhoff catheter was removed within 1 week of the diagnosis of FP; 31.9% of the patients who had the Tenckhoff catheter removed did not have the catheter replaced because of death or transfer to hemodialysis. In the patients who developed FP, 68.1% had the Tenckhoff catheter replaced; of these patients, 90.6% and 59.4% were on CPD therapy 1 and 6 months after catheter replacement, respectively. We conclude that risk factors identified in our population include peritonitis rate and prior antibiotic use. Fungal peritonitis is rare in our CPD population, and although it leads to significant CPD drop-out, it can be managed in many patients with antifungal therapy, early catheter removal, and temporary hemodialysis. Of the catheters replaced between 2 and 8 weeks after the diagnosis of FP, 91% functioned successfully, allowing continuation of CPD.
Insights
Fungal peritonitis (FP) is a rare complication of chronic peritoneal dialysis (CPD). Higher peritonitis rates and prior antibiotic use are key risk factors for FP, which can be managed with antifungal drugs and catheter management.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Fungal peritonitis (FP) is a serious complication of chronic peritoneal dialysis (CPD).
- Risk factors and optimal management strategies for FP remain debated.
- FP is associated with high morbidity and patient drop-out from CPD therapy.
Purpose of the Study:
- To identify risk factors for fungal peritonitis in CPD patients.
- To examine the outcomes of different treatment strategies for FP.
- To evaluate the long-term success of CPD following FP management.
Main Methods:
- Retrospective review of 704 CPD patients between March 1984 and August 1994.
- Analysis of 1,712 peritonitis episodes, identifying 55 cases of FP.
- Comparison of patient demographics, comorbidities, and peritonitis rates between FP and non-FP groups.
Main Results:
- Prior antibiotic use (87.3%) and higher peritonitis rates (1 episode/5.1 months) were significant risk factors for FP.
- Candida species caused 74.5% of FP episodes.
- Early Tenckhoff catheter removal (within 1 week) was performed in 85.5% of cases, with 68.1% of patients having catheter replacement, leading to successful CPD continuation in 90.6% at 1 month and 59.4% at 6 months.
Conclusions:
- Higher peritonitis rates and prior antibiotic exposure are significant risk factors for fungal peritonitis in CPD patients.
- While FP leads to significant CPD discontinuation, effective management includes antifungal therapy, early catheter removal, and temporary hemodialysis.
- Catheter replacement between 2–8 weeks post-diagnosis demonstrated a 91% success rate for continued CPD therapy.