Clinical features of and risk factors for fungal peritonitis in peritonealdialysis patients

Background and purpose: Fungal peritonitis (FP) is a serious complication f or peritoneal dialysis (PD) patients and can result in technical failure an d mortality. Catheter removal remains the mainstay of treatment. This study sought to identify the risk factors for FP in order to facilitate the prev ention of this catastrophic complication. Methods: A total of 246 patients who received long-term PD from 1985 to 199 8 were included in this retrospective study. Twenty episodes of FP occurred in 19 patients, The clinical characteristics, pathogens, treatment modalit ies, and outcomes of the FP episodes were retrospectively reviewed. The FP incidence in various demographic and clinical groups, classified according to sex, age, education, and underlying cause of uremia, were compared with the Poisson test. Results: Thirteen episodes of FP were caused by yeast, and the remaining ep isodes were caused by Aspergillus spp. Age, sex, and education did not affe ct thr FP incidence. Lupus patients (969 patient-months) bad a higher incid ence of FP than patients with other underlying diseases (P < 0.05). The 19 FP patients also had a higher incidence of bacterial peritonitis than other PD patients (p < 0.01). Among the 20 FP episodes, 14 (70%) were preceded b y antibiotic use, and eight (40%) developed during hospitalization. Steroid s were used at the time of FP in five of six lupus patients. Seven patients (37%) died within 1 month after diagnosis of FP. Five patients were able t o remain on PD after FP, but only three patients were able to maintain cath eter placement. Conclusion: The risk factors for FP identified in this study include the us e of antibiotics and steroids, underlying lupus, frequent occurrence of bac terial peritonitis, and hospitalization. Antifungal therapy may allow the c atheter to be kept in place in a few patients, but catheter removal should be considered in patients whose FP is refractory to medical treatment.