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.
Hooman
Nakysa
N
Division of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran. nakisa45@yahoo.com
Madani
Abbas
A
Sharifian Dorcheh
Mostafa
M
Mahdavi
Ali
A
Derakhshan
Ali
A
Gheissari
Alaleh
A
Esfahani
Seyed Taher
ST
Otukesh
Hassan
H
Mohkam
Masoumeh
M
Falahzadeh
Mohammad Hossein
MH
Hosseini Al Hashemi
Ghamar
G
Azir
Afshin
A
Merikhi
Alireza
A
Golikhani
Fatemeh
F
Latif
Elahe
E
Karimi
Shirin
S
Zakavat
Talieh
T
Mohseni
Parvin
P
Ataei
Neamatollah
N
Nickavar
Azar
A
Basiratnia
Mitra
M
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