Fungal peritonitis complicating peritoneal dialysis: report of 18 cases and analysis of outcomes.

Fungal peritonitis is a significant cause of morbidity and mortality in patients undergoing peritoneal dialysis (PD). This retrospective study evaluated patients with fungal peritonitis in our dialysis unit from December 1999 through September 2003. We analyzed the demographic and clinical characteristics of patients to identify possible risk factors. Main clinical outcomes of interest were technique survival and mortality. During the study period, 18 patients were diagnosed with fungal peritonitis (15 on continuous ambulatory PD, 3 on automated PD). Fungal peritonitis accounted for 6% of all peritonitis episodes during the study period. Candida species were the infecting organism in 15 patients (83%). All 18 patients received antifungal treatment according to the International Society of Peritoneal Dialysis (ISPD) recommendations that were current during the study period. Two patients (11%) died with the PD catheter in situ, and 1 patient died after dialysis was withdrawn because of deterioration in other comorbid conditions. All the surviving patients were switched to hemodialysis. Of the 18 patients, 15 (83%) had history of antibiotic treatment for bacterial peritonitis within the 4 weeks preceding the fungal peritonitis episode. Our study provides further support for the current ISPD recommendation that the PD catheter should be removed as soon as a diagnosis of fungal peritonitis is made in a patient.