title: Fungal peritonitis in patients undergoing peritoneal dialysis (PD) in Brazil: molecular identification, biofilm production and antifungal susceptibility of the agents.
abstract: This paper presents data on fungal peritonitis (FP) in patients undergoing peritoneal dialysis (PD) at the University Hospital of Botucatu Medical School, São Paulo, Brazil. In a total of 422 patients, 30 developed FP, from which the medical records and the fungal isolates of 23 patient cases were studied. All patients presented abdominal pain, cloudy peritoneal effluent, needed hospitalization, had the catheter removed and were treated with fluconazole or fluconazole plus 5-flucitosine; six of them died due to FP. Concerning the agents, it was observed that Candida parapsilosis was the leading species (9/23), followed by Candida albicans (5/23), Candida orthopsilosis (4/23), Candida tropicalis (3/23), Candida guilliermondii (1/23), and Kodamaea ohmeri (1/23). All the isolates were susceptible to amphotericin B, voriconazole and caspofungin whereas C. albicans isolates were susceptible to all antifungals tested. Resistance to fluconazole was observed in three isolates of C. orthopsilosis, and dose-dependent susceptibility to this antifungal was observed in two isolates of C. parapsilosis and in the K. ohmeri isolate. Biofilm production estimates were high or moderate in most isolates, especially in C. albicans species, and low in C. parapsilosis species, with a marked variation among the isolates. This Brazilian study reinforces that FP in PD is caused by a diverse group of yeasts, most prevalently C. parapsilosis sensu stricto species. In addition, they present significant variation in susceptibility to antifungals and biofilm production, thus contributing to the complexity and severity of the clinical features.
authors.affiliation: Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP, Botucatu.
authors.forename: Juliana
authors.initials: J
authors.lastname: Giacobino
authors.affiliation: Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP, Botucatu.
authors.forename: Augusto Cezar
authors.initials: AC
authors.lastname: Montelli
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP.
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
authors.affiliation: Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP, Botucatu.
authors.forename: Ariane
authors.initials: A
authors.lastname: Bruder-Nascimento
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP.
authors.forename: Jacqueline Teixeira
authors.initials: JT
authors.lastname: Caramori
authors.affiliation: Departamento de Bioestatística, Instituto de Biociências, UNESP, Botucatu.
authors.forename: Luciano
authors.initials: L
authors.lastname: Barbosa
authors.affiliation: Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP, Botucatu.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bagagli
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D018441:Biofilms / Q000254:growth & development*; D001938:Brazil; D025141:Drug Resistance, Fungal; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000382:microbiology*; D012189:Retrospective Studies; D004718:Saccharomycetales / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology*; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents
keywords: Candida spp.; antifungal susceptibility; biofilm; peritoneal dialysis; peritonitis