Clinical Features and Risk Factors of Fungal Peritonitis in Children on Peritoneal Dialysis

Abstract

Objective: To analyse the clinical manifestations, aetiology, prognosis, and risk factors of fungal peritonitis (FP) in children on peritoneal dialysis (PD).Methods: Among 322 children undergoing PD at Children's Hospital of Fudan University, between January 2001 and December 2019, FP cases were retrospectively analysed and compared with those of bacterial peritonitis (BP) to analyse the risk factors of FP.Results: A total of 124 cases of peritonitis were treated, including 11 FP cases in 11 children (0.0019 episodes/patient*month) and 113 BP cases in 64 children (0.02 episodes/patient*month). Among the 11 FP cases, 7 cases (63.64%) were caused by Candida and Candida parapsilosis (5/7) was the most common pathogen of Candida. All FP patients were converted to haemodialysis (HD) and did not resume PD during follow-up. Two patients (18.2%) died after 6 months of HD due to heart failure, 2 patients underwent kidney transplant after 2 years of infection, and the other 7 patients were still on HD. The univariate analysis showed the usage rate of antibiotics in the month before the onset of peritonitis was higher (45.45 vs. 15.93%) and the mean serum albumin was lower (31.4 vs. 34.4 g/L) in the FP group when compared with BP group (P < 0.05), while multivariate analysis showed that serum albumin ≤ 30 g/L was an independent risk factor for FP (odds ratio 4.896, 95% confidence interval 1.335–17.961).Conclusion: FP is a rare complication of PD in children, but it is associated with high technique failure. Attention should be paid to hypoproteinaemia and antibiotic use in children on PD.

Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study

“…The current studies (6,13) revealed that previous use of antibiotics, previous BP, under immunosuppression, higher burden of comorbidities (such as diabetes, malnutrition), prolonged PD duration and loss of residual kidney function are common risk factors for FP. Due to the overgrowth of gastrointestinal fungi and the decline of peritoneal defenses, FP is more likely to develop secondary to antibiotics exposure (7).…”

“…FP is relatively rare compared to BP, accounting for only 1-12% of patients with PDAP (6)(7)(8)(9)(10)(11)(12). It was reported that antibiotic use history, prolonged PD duration, malnutrition or hypoalbuminemia, and diabetes are usually identified as important risk factors for the occurrence of FP (6,13). FP is related to high hospitalization rates, catheter removal, permanent transfer to HD, and death (12,14), and the treatment method is relatively limited.…”

Fungal Peritonitis Associated With Peritoneal Dialysis Due to Non-Albicans Candida: A Case Series

“…This was derived from early catheter removal and introduction of antifungal drugs after evidence of the microorganism. The mortality in the worldwide is high if the catheter is not removed early (50-91%) [ 7 ]. The clinical and laboratory characteristics of the four cases are shown in Table 1 .…”