Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis: a national experience.
BACKGROUND
Fungal peritonitis (FP), causing catheter obstruction, dialysis failure, and peritoneal dysfunction, is a rare but serious complication of peritoneal dialysis. In this study, the frequency and risk factors of FP are evaluated in children who underwent peritoneal dialysis.


METHODS
A retrospective multicenter study was performed at the 5 pediatric peritoneal dialysis centers in Iran from 1971 to 2006, and FP episodes among 93 children were reviewed. Risk ratios were calculated for the clinical and demographic variables to determine the risk factors of FP.


RESULTS
Ninety-three children aged 39 months on average were included in study. Sixteen out of 155 episodes of peritonitis were fungi infections, all by Candida albicans. The risk of FP was higher in those with relapsing bacterial peritonitis (P = .009). Also, all of the patients had received antibiotics within the 1 month prior to the development of FP. Catheters were removed in all patients after 1 to 7 days of developing FP. Six out of 12 patients had catheter obstruction and peritoneal loss after the treatment and 5 died due to infection.


CONCLUSIONS
Fungal peritonitis, accompanied by high morbidity and mortality in children should be reduced by prevention of bacterial peritonitis. Early removal of catheter after recognition of FP should be considered.
Division of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran. nakisa45@yahoo.com
Nakysa
N
Hooman
Abbas
A
Madani
Mostafa
M
Sharifian Dorcheh
Ali
A
Mahdavi
Ali
A
Derakhshan
Alaleh
A
Gheissari
Seyed Taher
ST
Esfahani
Hassan
H
Otukesh
Masoumeh
M
Mohkam
Mohammad Hossein
MH
Falahzadeh
Ghamar
G
Hosseini Al Hashemi
Afshin
A
Azir
Alireza
A
Merikhi
Fatemeh
F
Golikhani
Elahe
E
Latif
Shirin
S
Karimi
Talieh
T
Zakavat
Parvin
P
Mohseni
Neamatollah
N
Ataei
Azar
A
Nickavar
Mitra
M
Basiratnia
D002176:Candida albicans; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate