Elsevier

Journal of Infection

Volume 48, Issue 1, January 2004, Pages 96-101
Journal of Infection

Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: a single centre Indian experience

https://doi.org/10.1016/S0163-4453(03)00119-1Get rights and content

Abstract

Background. Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We reviewed our FP cases to analyse the causative agents and possible risk factors in relation to FP and its outcome and mortality.

Methods. Records of all FP cases were reviewed. FP was diagnosed based on effluent cell count and positive fungal culture in suitable media.

Results. Between October 1993 and November 2001, 261 patients underwent CAPD. FP was detected in 28 patients, one episode in each patient (14.3% of the total peritonitis episodes). Candida species and dematiaceous fungi±Candida species were responsible for 89.3 and 10.7% of episodes, respectively. Patients with preceding bacterial peritonitis (BP) developed FP more frequently (25.6%) than de novo cases (2.9%) (P<0.0001) and lower proportion of them continued CAPD (8.6% vs. 60%; P=0.007). Mortality in patients having abdominal pain with and without fever, and catheter in situ was significantly higher than in those patients who did not have these risk factors (9/11 vs. 6/17, P=0.01; 13/17 vs. 2/11, P=0.003; 6/6, vs. 9/22, P=0.01, respectively).

Conclusions. Higher proportion of our patients had FP; preceding BP was a significant risk factor for development of FP and technique failure. Abdominal pain±fever in patients and catheter in situ were identified as risk factors associated with mortality.

Introduction

Peritonitis is one of the frequent and serious complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Although the most cases of CAPD peritonitis are of bacterial origin, fungal peritonitis (FP) comprises 2–15% of episodes with involvement of a wide variety of yeast-like and mould fungi.1., 2., 3., 4. FP is often severe, potentially life threatening and associated with significant morbidity and mortality. It poses difficult management problems and may lead to termination of CAPD programme.5., 6. Risk factors that predispose to FP remain unclear. Etiologic agents and outcome of FP also vary from centre to centre, in fact most of the reports on FP are from developed countries. Factors responsible for FP and its subsequent outcome are least understood worldwide and especially so in the developing world, and data from developing countries are lacking.

In the present report, we retrospectively reviewed our experience on FP in 28 patients at our centre over a period of 8 years. In particular, patients' demography, fungal agents, factors likely to predispose to FP and influence the outcome and mortality were analysed.

Section snippets

Materials and methods

Between October 1993 and November 2001, 261 patients with end stage renal disease (ESRD) were started CAPD at our dialysis centre. Records of all patients with FP were reviewed retrospectively to retrieve data on patients' demography, sign-symptoms, fungal agents, therapy offered, factors that predisposed to the development of FP and outcome of FP. Diagnostic criteria for FP included (1) cloudy effluent containing white cell count ≥100/μl with a differential count of >50% polymorphonuclear

Results

A total of 261 patients were treated with CAPD using Tenckhoff catheters during the study period. A cumulative total of 196 episodes of peritonitis were recorded in 95 patients; fungi caused 28 of the 196 episodes. FP accounted for 14.3% of all peritonitis episodes. FP rate was 0.09 episodes per patient year, while bacterial peritonitis rate was 0.63 per patient year (P<0.001).

Demographic data and clinical characteristics of the patients with fungal peritonitis are shown in Table 1. Mean age

Discussion

FP is reported to be an infrequent but serious complication with significant morbidity and mortality in patients undergoing CAPD.1., 2., 3., 4., 5. This has been further substantiated by the present study where the episode of FP was 0.09 per patient year but median hospital stay of patients with FP was 29 days and mortality was 53.6%.

FP is a leading cause of technique failure and dropout from the CAPD programme.5., 6. The incidence of FP comprises 2–15% of total peritonitis episodes as reported

References (16)

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