Fungal Peritonitis Among the Peritoneal Dialysis Patients of Four Turkish Centres

Abstract

This study evaluates the clinical findings and treatment of continuous ambulatory peritoneal dialysis (CAPD) patients with fungal peritonitis in Istanbul from 2000 to 2010. The clinical records of 15 patients with fungal peritonitis among the total 795 patients were reviewed for the clinical and laboratory data. The mean duration of dialysis from the initiation of treatment until the development of fungal peritonitis was 41.14 months. Fungal peritonitis was the primary episode of infection in eight patients. In five other patients previous intensive antibiotherapy was documented. The isolated mircoboes were Candida albicans in six, non-C. albicans in eight and Aspergillus fumigatus in one patient. Tenckoff catheters were removed in all cases and antifungal treatment was given for a minimum of three weeks. Two patients died in the hospital due to the fungal infection whereas others were transferred to haemodialysis. This study highlights the importance of removing the catheter and initiating antifungal therapy as soon as possible in cases of fungal peritonitis because it is responsible for high morbidity and mortality.

Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar

“…As noted, fungi accounted for 9.9% of all peritonitis episodes in our study, which falls within the reported range of 2-16% described in the literature [4][5][6][7][8][9][10][11][12]. Fungi enter the peritoneal cavity through touch contamination at the time of PD exchange or invasion of skin by the offending organisms from the exit site through the tunnel to the peritoneum [13].…”

“…In addition, many reports have shown that prior antibiotic use is an important risk factor predisposing to the development of fungal peritonitis. The reported incidence of prior antibiotic exposure in CAPD patients with fungal peritonitis ranges from 55-94% [11][12][13][14][15][16][17][18]. Goldie et al [18] reported that 65% of fungal peritonitis patients had received broadspectrum antibiotics within the preceding month, 74% within three months, and 87% within six months.…”

“…The causative organisms are usually bacteria [3]. Fungi are uncommonly implicated, being responsible for only 2-16% of all peritonitis episodes associated with CAPD [4][5][6][7][8][9][10][11][12]. Fungal peritonitis, if not detected early and treated appropriately, is associated with increased morbidity (development of peritoneal adhesions and inability to resume CAPD) and mortality.…”

“…Fungal peritonitis, if not detected early and treated appropriately, is associated with increased morbidity (development of peritoneal adhesions and inability to resume CAPD) and mortality. The mortality rate varies from 5% to 53%, while failure to resume CAPD occurs in up to 40% of the patients [6][7][8][9][10][11][12].…”

Aspergillus niger peritonitis in a patient on continuous ambulatory peritoneal dialysis

“…The fungus colonizes the peritoneal catheter and is embedded in the amorphous matrix on the surface of the catheter leading to fungal peritonitis. 11,12 Our patient had received antibiotic therapy for an episode of peritonitis due to Pseudomonas aeruginosa. However, it is not clear as to whether fungal infection followed bacterial peritonitis or was concurrently present along with fungal peritonitis as the symptoms did not resolve despite of antibiotic therapy.…”