title: Fungal peritonitis in children on peritoneal dialysis.
abstract: Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.
authors.affiliation: Pediatric Nephrology, Radboud University, Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands. r.raaijmakers@cukz.umcn.nl
authors.forename: Renske
authors.initials: R
authors.lastname: Raaijmakers
authors.forename: Cornelis
authors.initials: C
authors.lastname: Schröder
authors.forename: Leo
authors.initials: L
authors.lastname: Monnens
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cornelissen
authors.forename: Adilla
authors.initials: A
authors.lastname: Warris
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000472:pathogenicity; D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D009426:Netherlands; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole