Fungal Peritonitis During Continuous Ambulatory Peritoneal Dialysis: A Report of 17 Cases

Rubin, Jack; Kirchner, Kent A.; Walsh, David A.; Green, Mike; Bower, John D.

doi:10.1016/s0272-6386(87)80102-6

Cited by 47 publications

(30 citation statements)

References 30 publications

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“…On the other hand, in no case of apparently sterile peritonitis were the specific fungal cultures positive. It does not, therefore, seem necessary, for routine purposes, to grow cultures in specific fungal media, a conclusion confirmed by Rubin et al [4], Both in our series and in those quoted in reviews of the literature [2-4, 17, 18], yeast agents were the fungal agents found to be responsible for about 90% of the FP cases among patients on PD. They include the Candida organ isms, especially the C. albicans species, followed by Can dida parapsi/osis and Candida tropicalis.…”

Section: Discussionsupporting

confidence: 86%

“…Our results confirm the absence of specificity of the signs observed in FP, as these signs were completely superimposable on those of bacterial peritonitis and did not enable the etiological diagnosis to incriminate a par ticular fungal agent [2][3][4]8], The same applies to the cell counts of peritoneal fluid. On the other hand.…”

Section: Discussionsupporting

confidence: 61%

“…The relative rarity of fun gal infection suggests that other factors are also involved, but neither age nor sex seem to be implicated. The role of diabetes has been variously evaluated in different series [4,14], but in most studies, the diabetic patients treated by PD do not seem to have been more exposed to FP than the nondiabetic patients. The tendency of immunosup pressive treatment to favor fungal infection found in our series was also reported by Rault [15].…”

Section: Discussionmentioning

confidence: 99%

“…Local peritoneal factors have been seen to play an important part in fostering FP in all series reported [2][3][4]8]: thus, most patients with this disease were found to have had either bacterial peritonitis and/or antibiotic therapy (generally administered intraperitoneally) during the month preceding FP. This was also the case in the present series.…”

Section: Discussionmentioning

confidence: 99%

“…During the last years, the problems arising from perito neal infection in patients receiving peritoneal dialysis (PD) have changed [1], The frequency of bacterial perito-cases observed among PD patients [2][3][4] and for which morbidity and mortality rates are still high [5,6]. Few investigations have dealt with the impact of progress in therapy on the prevention of this complication and on its treatment which is still controversial [7,8], As yet.…”

Section: Introductionmentioning

confidence: 99%

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Fungal Peritonitis in Patients on Peritoneal Dialysis

et al. 1994

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Fungal peritonitis (FP) is a serious complication of peritoneal dialysis, both in terms of morbidity and mortality. Available data on the effectiveness of fluconazole in eradicating FP without catheter removal are still controversial. We reviewed 20 FP cases that occurred among 325 patients who underwent peritoneal dialysis in our center between January 1984 and January 1992, in order to establish whether a profile of patients at risk of developing FP could be identified and to evaluate the effectiveness of fluconazole in treating FP (7 cases). Age, sex, a particular cause of end-stage renal disease, and the presence of diabetes did not correlate significantly with the development of FP. The risk of FP increased in patients on immunosuppressive treatment. Sixteen of our 20 patients had bacterial peritonitis during the month before they developed FP. Nineteen were treated with antibiotics. Neither the type of bacterial organism isolated during the bacterial peritonitis preceding FP nor modality and duration of antibiotic treatment correlated significantly with the development of FP. Patients who subsequently developed FP were more frequently treated with antibiotics while in hospital (p < 0.001). Candida species accounted for 15 of our 20 FP cases (75 %), with Candida albicans being by far the most common isolate. Treatment strategies varied among the 20 patients. The combination of intravenous or intraperitoneal administration of 5-fluoro-cytosine and oral administration of fluconazole was used in 7 cases: only 1 patient was cured without catheter removal, 1 patient died within the first 4 days of treatment, removal of peritoneal catheter was necessary in the other 5 patients. The main risk factors for the development of FP are a recent episode of bacterial peritonitis and recent exposure to antibiotics, especially when antibiotics were administered while in hospital. Under these circumstances, prophylactic administration of fluconazole should be considered. Despite initially favorable reports, fluconazole does not avoid the need for catheter removal to eradicate FP in most cases.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%