Fungal peritonitis in patients receiving peritoneal dialysis: Experience with 11 patients and review of the literature

Despite progress in decreasing the incidence of and improving the therapy for bacterial peritonitis in patients receiving peritoneal dialysis, fungal peritonitis has emerged as a relatively common infection. Hospitalization, recent prior episodes of peritonitis, and antibacterial therapy appear to predispose patients to this infection. Clinically, fungal peritonitis cannot be differentiated from bacterial peritonitis except by gram stain and culture of the dialysate. The most commonly made serious error is the failure to initiate appropriate therapy quickly enough on the basis of these diagnostic parameters. For patients who no longer require dialysis, those for whom a change to hemodialysis is preferred, and those with concomitant life-threatening illnesses, the recommended therapy for fungal peritonitis is removal of the dialysis catheter and the institution of therapy with systemic antifungal agents. For patients who are hemodynamically and metabolically stable and for whom continued peritoneal dialysis is desirable, a trial of antifungal chemotherapy before removal of the catheter may be indicated.