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Article Review/Hyperlink
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Goldie SJ, Kiernan-Troidle L, Torres C, Gorban-Brennan N,
Dunne D, Kliger AS, Finkelstein FO
Fungal peritonitis in a large chronic peritoneal dialysis
population: A report of 55 episodes
Am J Kidney Dis
(Jul) 28:86-91 1996

Fungal peritonitis is a serious complication of chronic
peritoneal dialysis (CPD) therapy. The objective of this paper
was to determine the risk factors and outcome with various
treatment strategies in a single unit over a 10 year period
(1984-1994). Of 704 patients on CPD, there were a total of 1712
episodes of peritonitis and 55 episodes of fungal peritonitis
(3.2%). Patients developing fungal peritonitis were similar to
those with other forms of peritonitis with respect to age,
gender, etiology of ESRD, and comorbid disease. However,
incidence of peritonitis (1/5.1 months vs. 1/9.9 months) was
higher in the fungal peritonitis group.
Antibiotic therapy was
given during the previous 6 months in 87.3% of patients with
fungal peritonitis, and 6 patients had received an
immunosuppressive agent within the past 2 weeks. All patients
received antifungal drugs, usually either amphotericin B alone or
in combination with fluconazole (5 patients recieved only
fluconazole and/or flucytosine). 47 patients underwent catheter
removal; however, of the 8 who did not have catheters removed, 4
were able to continue CPD. Overall, only 27 patients were able
to continued CPD, 17 were transferred to HD, and 11 died. In
patients undergoing catheter removal followed by antifungal
therapy, PD was subsequently successfuIly performed in 91% of
patients.
In conclusion, fungal peritonitis is uncommon but
accounts for serious mobidity and mortality. Previous antibiotic
use is the major identifiable risk factor. The best approach is
probably antifungal therapy plus early catheter removal,
temporary hemodialysis, with replacement of the PD catheter 2-8
weeks later after resolution of symptoms.
Comment:
This is a helpful report to clinicians because of the
large number of patients reported. It is of note that only one
patient was treated with the combination of oral flucytosine and
fluconazole, which is currently recommended by the Peritonitis
Advisory Group for fungal peritonitis.
(David J. Leehey, M.D., Loyola University at Chicago)
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