Fungal
peritonitis causes significant morbidity and mortality for patients undergoing
continuous ambulatory peritoneal dialysis (
CAPD). We retrospectively 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 fungal
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 long-term
hemodialysis. Only 37% managed to continue
CAPD. The remaining 5% either underwent
transplantation or were lost to follow-up. We identified the factors associated with poor outcome, namely mortality and technique failure. The presence of
abdominal pain, bowel obstruction, and a
catheter remaining in situ were significantly associated with greater mortality.
Abdominal pain,
antibiotic use within 3 months before fungal
peritonitis, and complication by bowel obstruction were associated with greater technique failure. In choosing
antifungal agents with
catheter removal, oral
fluconazole alone appears equally as effective as combined oral
fluconazole with 5-flucytosine for
peritonitis caused by Candida species. For
peritonitis caused by species other than Candida, the choice of antifungal
therapy needs to be individualized, based on fungal species and sensitivities.