Non Candida albicans fungal peritonitis in continuous ambulatory peritoneal dialysis patients.
We report four episodes of non Candida albicans peritonitis (NCAP) in 3 patients on continuous ambulatory peritoneal dialysis (CAPD). Risk factors for NCAP included diabetes mellitus and prior antibiotic use in half of the cases. The antibiotic treatment was prescribed for exit-site infection (ESI) or peritonitis in the patient. Treatment for NCAP included antifungal therapy with oral fluconazole or intravenous amphotericin B. The NCAP resulted in catheter loss in 100% of the patients over time. Initial catheter salvage in one patient was followed 6 months later by catheter loss following treatment of a bacterial peritonitis that was complicated by the development of Candida (Torulopsis) glabrata peritonitis unresponsive to treatment with intravenous amphotericin B. Although the literature suggests that Candida peritonitis responds to oral fluconazole with and without catheter removal, this series suggests that the treatment of NCAP includes removal of the peritoneal dialysis catheter with appropriate antifungal agents.
Kleinpeter
M A
MA
Tulane University Health Sciences Center, Section of Nephrology, New Orleans, Louisiana, USA.
Butt
A A
AA
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D002408:Catheters, Indwelling; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012307:Risk Factors
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole