Fungal peritonitis in children on peritoneal dialysis

Abstract

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

“…The reported prevalence of FP was 2% of all peritonitis episodes in data collected by the IPPR and 2.9% in a pediatric Dutch study (125,4). Recent data in adults reveal rates of 1.5% -5.8% (126).…”

“…Observational studies suggest that frequent peritonitis, particularly episodes with gram-negative organisms, recent antibiotic therapy, and immunosuppression, can all be risk factors for FP in adults and in children (125,(127)(128)(129)(130). Warady et al (130) found that 56% of children with FP had received antibiotics in the preceding month, half of them for bacterial peritonitis.…”

Candida albicans Pathogenesis: Fitting within the Host-Microbe Damage Response Framework

“…Intraabdominal candidaisis (IAC) results from entry of C. albicans into the abdominal cavity through translocation across the GI mucosal barrier or by direct inoculation, which can occur via contaminated peritoneal dialysis catheters or as a result of perforation of the GI tract (85)(86)(87)(88) (Fig. 2C).…”

Peritonitis Due to Blastobotrys proliferans in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

“…Candida species are the most common fungi isolated (6,26,27). Peritonitis due to various filamentous fungi is also reported.…”