Factors predicting outcome of fungal peritonitis in peritoneal dialysis: Analysis of a 9-year experience of fungal peritonitis in a single center

Fungal peritonitis causes significant morbidity and mortality for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We retrospecti vely reviewed 70 episodes of fungal peritonitis in a single center over the last 9 years in 896 CAPD patients. Seventy percent of the episodes of fung al peritonitis were caused by Candida species, among which 50% were Candida parapsilosis. As a result of fungal peritonitis, 44% of the patients died, whereas further peritoneal dialysis failed in 14%, requiring a change to l ong-term hemodialysis. Only 37% managed to continue CAPD. The remaining 5% either underwent transplantation or were lost to follow-up. We identified t he factors associated with poor outcome, namely mortality and technique fai lure. The presence of abdominal pain, bowel obstruction, and a catheter rem aining in situ were significantly associated with greater mortality. Abdomi nal pain, antibiotic use within 3 months before fungal peritonitis, and com plication by bowel obstruction were associated with greater technique failu re. In choosing antifungal agents with catheter removal, oral fluconazole a lone appears equally as effective as combined oral fluconazole with 5-flucy tosine for peritonitis caused by Candida species. For peritonitis caused by species other than Candida, the choice of antifungal therapy needs to be i ndividualized, based on fungal species and sensitivities. (C) 2000 by the N ational Kidney Foundation, Inc.