title: Fungal peritonitis in continuous ambulatory peritoneal dialysis--the Auckland experience.
abstract: Fungal infection is an uncommon cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We report our center's experience with 38 episodes of fungal peritonitis occurring in 33 patients, out of a total of 503 patients managed on CAPD over 11 1/2 years, and review the relevant literature. Our usual management philosophy has been one of early peritoneal catheter removal without antifungal therapy. In those with worsening clinical features, and in those with persistence of signs and symptoms beyond 48 hours after catheter removal, antifungal drugs were administered. Only five patients received antifungal therapy initially, followed by later catheter removal. Seventy-six percent of patients treated by catheter removal alone (N = 21) and 64% of patients treated by catheter removal followed by antifungal therapy (N = 11) were successfully reestablished on CAPD. A policy of early catheter removal, usually alone, but followed by antifungal therapy in select cases, can be associated with a mortality rate of less than 15% and a high rate of return to effective peritoneal dialysis.
authors.affiliation: Department of Medicine, Auckland Hospital, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Nagappan
authors.forename: J F
authors.initials: JF
authors.lastname: Collins
authors.forename: W T
authors.initials: WT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001424:Bacterial Infections; D002177:Candidiasis; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy; D009520:New Zealand; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents