Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients

Abstract

Twenty-one episodes of fungal peritonitis occurred over 35 months among 290 patients on CAPD, accounting for 6.3% of all peritonitis episodes. Patients with more frequent bacterial peritonitis were at higher risk of developing fungal peritonitis, and 28.6% of cases followed antimicrobial therapy. Candida species accounted for 85.7% of cases. Oral fluconazole was used as initial therapy in all patients, which was followed by catheter removal if peritonitis failed to improve. The cure rate with fluconazole therapy alone without catheter removal was 9.5%. Fluconazole plus catheter removal, the latter necessitated in 85.7% of cases, resulted in a cure rate of 66.7%. The remaining 3 (14.3%) patients responded to intravenous amphotericin given as salvage therapy. Disease-related mortality was 14.3%. Reinsertion of dialysis catheter was attempted in 15 patients and CAPD was successfully resumed in 13 (86.7%). We conclude that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD. Although catheter removal was necessary in the majority of patients, this sequential approach resulted in a relatively low prevalence of peritoneal adhesions and subsequent CAPD failure.

Fungal peritonitis in children on peritoneal dialysis

“…Several studies have shown that fluconazole monotherapy is effective and reaches good plasma and dialysate concentrations when given orally [22][23][24] as well as intraperitoneally [22,25,26]. Chen et al [27] recently compared oral fluconazole monotherapy with either amphotericin B intraperitoneally or amphotericin B intraperitoneally combined with fluconazole orally or intravenously.…”

The surgical management of peritoneal dialysis catheters

“…42,43 Incidence ranges between 0.5-1.4 episodes per patient per year, 44 with about 60% of patients developing peritoneal dialysis peritonitis in the first year. 45 At least a quarter will culminate in catheter failure.…”

Accelerated recovery from Candida peritonitis of enteric origin by early surgical drainage in a peritoneal dialysis patient

“…Recent reports on fungal peritonitis in children receiving peritoneal dialysis have indicated the usefulness of vigorous peritoneal lavage through the catheter [17,18]; however, its overall efficacy is still controversial, because it delays the timing of catheter removal [19]. Furthermore, after catheter removal alone, or with antifungal therapy, the signs and symptoms of fungal peritonitis may remain for more than 7 days [20][21][22]. In our case, however, the systemic inflammatory findings rapidly returned to normal ranges after surgery (Fig.…”