title: Risk of technique failure and death in fungal peritonitis is determined mainly by duration on peritoneal dialysis: single-center experience of 24 years.
abstract: Fungal peritonitis (FP) is an infrequent cause of peritonitis in peritoneal dialysis (PD), but it has high morbidity and mortality. We analyzed the experience with FP in a single PD unit over a 24-year period. We identified 671 episodes of peritonitis that occurred in 496 patients during the study period. Of these episodes, 23 (3.4%) were FP episodes occurring in 21 patients. In the FP episodes, the patients' mean time on PD was 29.2 +/- 27 months. In 5 episodes, the patients had experienced a peritonitis episode within the preceding month, and in 11 episodes, the patients had used antibiotics within the preceding month. The FP diagnosis was made a mean of 3.17 +/- 3 days after the diagnosis of peritonitis, and in 1 patient, the diagnosis was made after death. Candida spp. were isolated in 82.6% of patients. In 91.3%, the peritoneal catheter was removed. After the FP diagnosis, 15 patients dropped out of PD, but in only 8 patients (34.7%) was drop-out related to FP. In 4 patients, drop-out occurred because of peritoneal membrane failure, and 4 patients (17.4%) died. Time on PD was significantly higher in the group of patients that dropped out of PD because of the FP (45.7 +/- 31 months vs. 19 +/- 18 months, p = 0.02). Fungal peritonitis is a rare cause of peritonitis in PD patients, but it is associated with high morbidity and mortality. Longer time on PD is the main factor in technique failure and mortality.
authors.affiliation: Department of Nephrology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Felgueiras
authors.forename: Gloria
authors.initials: G
authors.lastname: del Peso
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Bajo
authors.forename: Covadonga
authors.initials: C
authors.lastname: Hevia
authors.forename: Sara
authors.initials: S
authors.lastname: Romero
authors.forename: Olga
authors.initials: O
authors.lastname: Celadilla
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents