Fungal Pathogens Cause Worse PD Peritonitis

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BOSTON—Fungal peritonitis has a worse prognosis than bacterial peritonitis in patients on peritoneal dialysis (PD), according to a study. It is associated with higher rates of catheter removal, technique failure, and mortality.

“The high mortality rate is reason for concern,” said lead investigator Ruchir Chavada, MD, an infectious disease specialist at Liverpool Hospital, Sydney, Australia.  “Patients who have fungal peritonitis have very high rates of hospitalization. They also have high rates of technique failure and a mortality rate of 15%.”

Dr. Chavada and his colleagues identified 39 PD patients with fungal peritonitis. The researchers compared these 39 patients with 78 PD patients who experienced bacterial peritonitis. The two groups did not differ with respect to age, gender, or co-morbidities, but patients with fungal peritonitis were more likely to have had previous peritonitis. Peritonitis occurred later in the fungal infection group than the bacterial infection group (1,153 vs. 824 catheter days).

Fungal peritonitis resulted in a higher proportion of catheter removals compared with bacterial peritonitis (66% vs. 25%). Fungal infections also required a longer duration of therapy (23 days vs. 10 days for bacterial episodes) and additional infection-related surgery (17% vs. 4% for bacterial episodes). The technique failure rates were 80 % in the patients experiencing fungal peritonitis compared with only 17% in the patients experiencing bacterial peritonitis. The 30-day mortality rate was 15% in the fungal peritonitis group compared with 12% in the bacterial peritonitis patients.

The two groups had similar clinical presentations. In 92% of cases, patients reported abdominal pain; 25% of patients had fever. Hypotension occurred in approximately 20% of patients suffering from either type of infection. The two groups showed no significant differences in C-reactive protein levels, white blood cell counts (WCC), and peritoneal fluid WCC.

“The best outcomes for fungal peritonitis were seen in patients who had their catheter removed as per the 2005 PD guidelines, which is consistent with other literature in relation to outcomes in fungal peritonitis,” Dr Chavada said.

In the fungal peritonitis group, Candida albicans was the most commonly isolated pathogen (14 cases, 36%). The next most commonly isolated pathogens were Candida parasilosis (10 cases, 25%), Candida glabrata (five cases, 14%), and Candida tropicalis (two cases, 5%).

Findings were presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy.

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