title: Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar.
abstract: BACKGROUND
  This study was conducted at Hamad General Hospital to determine the incidence of fungal peritonitis and to describe its clinical and microbiological findings in patients undergoing continuous ambulatory peritoneal dialysis in Qatar.
  
  
  METHODS
  The medical records of these patients between 1 January 2005 and 31 December 2008 were retrospectively reviewed and the collected data were analysed.
  
  
  RESULTS
  During the study period, 141 episodes of peritonitis were observed among 294 patients. In 14 of these episodes (9.9%), fungal peritonitis was reported in 14 patients with a rate of 0.05 episodes per patient year, while the bacterial peritonitis rate was 0.63 per patient year. Thirteen (93%) patients had one or more previous episodes of bacterial peritonitis that was treated with multiple broad-spectrum antibiotics, 11 (85%) had received broad-spectrum antibiotics within the preceding month, 12 (92%) within three months, and 8 (62%) within six months. Candida species were the only fungal species isolated from the dialysate with predominance of non-albicans Candida species (especially Candida parapsilosis). Therapeutic approach was immediate catheter removal, followed by systemic antifungal therapy and temporary haemodialysis. Nine patients (64.3%) were continued on haemodialysis, whereas five patients (35.7%) died.
  
  
  CONCLUSIONS
  Prior antibiotic use was an important risk factor predisposing patients to the development of fungal peritonitis. Early detection of fungal peritonitis would lead to early institution of appropriate therapy and prevention of complications.
authors.affiliation: Department of Medicine, General Medicine, Hamad General Hospital, Doha, Qatar. fakhanqal@yahoo.co.uk
authors.forename: Fahmi Yousef
authors.initials: FY
authors.lastname: Khan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Elsayed
authors.forename: Deshmukh
authors.initials: D
authors.lastname: Anand
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Khattab
authors.forename: Doiphode
authors.initials: D
authors.lastname: Sanjay
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002175:Candida / Q000472:pathogenicity; D020878:Device Removal / Q000295:instrumentation; D015314:Dialysis Solutions / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D011780:Qatar / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D015314:Dialysis Solutions; D015725:Fluconazole