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Fungal peritonitis in children on peritoneal dialysis

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Abstract

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.

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References

  1. Shin JH, Lee SK, Suh SP, Ryang DW, Kim NH, Rinaldi MG, Sutton DA (1998) Fatal Hormonema dematioides peritonitis in a patient on continuous ambulatory peritoneal dialysis: criteria for organism identification and review of other known fungal etiologic agents. J Clin Microbiol 36:2157–2163

    CAS  Google Scholar 

  2. Goldie SJ, Kiernan Troidle L, Torres C, Gorban-Brennan N, Dunne D, Kliger AS, Finkelstein FO (1996) Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes. Am J Kidney Dis 28:86–91

    Article  CAS  Google Scholar 

  3. Bordes A, Camposherrero MI, Fernandez A, Vega N, Rodriguez JC, Palop L (1995) Predisposing and prognostic factors of fungal peritonitis in peritoneal dialysis. Perit Dial Int 15:275–276

    CAS  PubMed  Google Scholar 

  4. Nagappan R, Collins JF, Lee WT (1992) Fungal peritonitis in continuous ambulatory peritoneal dialysis-the Auckland experience. Am J Kidney Dis 20:492–496

    Article  CAS  Google Scholar 

  5. Warady BA, Bashir M, Donaldson LA (2000) Fungal peritonitis in children receiving peritoneal dialysis: a report of the NAPRTCS. Kidney Int 58:384–389

    Article  CAS  Google Scholar 

  6. Warady BA, Sullivan EK, Alexander SR (1996) Lessons from the peritoneal dialysis patient database: a report of the NAPRTCS. Kidney Int 53:S68–S71

    CAS  Google Scholar 

  7. Lerner GR, Warady BA, Sullivan EK, Alexander SR (1999) Chronic dialysis in children and adolescents. The 1996 annual report of the North American Pediatric Renal Transplant Cooperative study. Pediatr Nephrol 13:404–417

    Article  CAS  Google Scholar 

  8. National Committee for Clinical Laboratory Standards (2002) Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard, 2nd edn, document M27–A2. National committee for Clinical Laboratory standards, Wayne, PA

  9. National Committee for Clinical Laboratory Standards (2002) Reference methods for broth dilution antifungal susceptibility testing of filamentous funghi; approved standards, NCCLS document M38–A. National Committee for Clinical Laboratory Standards, Wayne, PA

  10. Prasad KN, Prasad N, Gupta A, Sharma RK, Verma AK, Ayyagari A (2004) Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: a single centre Indian experience. J Infect 48:96–101

    Article  CAS  Google Scholar 

  11. Wang AYM, Yu AWY, Li PKT, Lam PKW, Leung CB, Lai KN, Lui SF (2000) Factors predicting outcome of fungal peritonitis in peritoneal dialysis: analysis of a 9-year experience of fungal peritonitis in a single center. Am J Kidney Dis 36:1183–1192

    Article  CAS  Google Scholar 

  12. Eisenberg ES, Leviton I, Soeiro R (1986) Fungal peritonitis in patients receiving peritoneal dialysis: experience with 11 patients and review of the literature. Rev Infect Dis 8:309–321

    Article  CAS  Google Scholar 

  13. Zaruba K, Peters J, Jungbluth H (1991) Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: six years’ experience. Am J Kidney Dis 17:43–46

    Article  CAS  Google Scholar 

  14. Prasad N, Gupta A (2005) Fungal peritonitis in peritoneal dialysis patients. Perit Dial Int 25:207–222

    PubMed  Google Scholar 

  15. Murugasu B, Conley SB, Lemire JM, Portman RJ (1991) Fungal peritonitis in children treated with peritoneal dialysis and gastrostomy feeding. Pediatr Nephrol 5:620–621

    Article  CAS  Google Scholar 

  16. Andrews PA, Warr KJ, Hicks JA, Cameron JS (1996) Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients. Nephrol Dial Transplant 11:1104–1108

    Article  CAS  Google Scholar 

  17. Bibashi E, Memmos D, Kokolina E, Tsakiris D, Sofianou D, Papadimitriou M (2003) Fungal peritonitis complicating peritoneal dialysis during an 11-year period: report of 46 cases. Clin Infect Dis 36:927–931

    Article  Google Scholar 

  18. Enriquez JL, Kalia A, Travis LB (1990) Fungal peritonitis in children on peritoneal dialysis. J Pediatr 117:830–832

    Article  CAS  Google Scholar 

  19. Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M, Mujais S, Verrina E, International Society for Peritoneal Dialysis (ISPD) Advisory Committee on Peritonitis Management in Pediatric Patients (2000) Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20:610–624

    CAS  Google Scholar 

  20. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper FJ, Li PK, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L, ISPD Ad Hoc Advisory Committee (2005) Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 25:107–131

    Google Scholar 

  21. Fabris A, Pellanda MV, Gardin C, Contestabile A, Bolzonella R (1993) Pharmacokinetics of antifungal agents. Perit Dial Int 13 (Suppl 2):S380–S382

    PubMed  Google Scholar 

  22. Debruyne D, Ryckelynck JP, Moulin M, Hurault DL, Levaltier B, Bigot MC (1990) Pharmacokinetics of fluconazole in patients undergoing continuous ambulatory peritoneal dialysis. Clin Pharmacokinet 18:491–498

    Article  CAS  Google Scholar 

  23. Chan TM, Chan CY, Cheng SW, Lo WK, Lo CY, Cheng IKP (1994) Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole-a series of 21 patients. Nephrol Dial Transplant 9:539–542

    Article  CAS  Google Scholar 

  24. Levine J, Bernard DB, Idelson BA, Farnham H, Saunders C, Sugar AM (1989) Fungal peritonitis complicating continuous ambulatory peritoneal dialysis: successful treatment with fluconazole, a new orally active antifungal agent. Am J Med 86:825–827

    Article  CAS  Google Scholar 

  25. Dahl NV, Foote EF, Searson KM, Fein JL, Kapoian T, Steward CA, Sherman RA (1998) Pharmacokinetics of intraperitoneal fluconazole during continuous cycling peritoneal dialysis. Ann Pharmacother 32:1284–1289

    Article  CAS  Google Scholar 

  26. Kameoka H, Kumakawa K, Matuoka T, Nakano M, Shiraiwa Y, Yamaguchi O (1999) Intraperitoneal fluconazole for fungal peritonitis in CAPD: report of two cases. Perit Dial Int 19:481–483

    CAS  PubMed  Google Scholar 

  27. Chen CM, Ho MW, Yu WL, Wang JH (2004) Fungal peritonitis in peritoneal dialysis patients: effect of fluconazole treatment and use of the twin-bag disconnect system. J Microbiol Immunol Infect 37:115–120

    CAS  PubMed  Google Scholar 

  28. Almoujahed MO, Riederer K, Baran J Jr (2003) Fungal peritonitis at a tertiary care community teaching hospital: epidemiology, treatments, and outcome over a 3 year time span. Mycoses 47:200–202

    Article  Google Scholar 

  29. Manzano-Gayosso P, Hernandez-Hernandez F, Mendez-Tovar LJ, Gonzalez-Monroy J, Lopez-Martinez R (2003) Fungal peritonitis in 15 patients on continuous ambulatory peritoneal dialysis (CAPD). Mycoses 46:425–429

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Pediatric Nephrology, Radboud University, Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands

    Renske Raaijmakers, Leo Monnens & Elisabeth Cornelissen

  2. Pediatric Nephrology, Wilhelmina Childrens Hospital, University Medical Centre Utrecht, Utrecht, Netherlands

    Cornelis Schröder

  3. Pediatric Infectious Diseases and Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands

    Adilla Warris

Authors
  1. Renske Raaijmakers
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  2. Cornelis Schröder
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  3. Leo Monnens
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  4. Elisabeth Cornelissen
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  5. Adilla Warris
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Correspondence to Renske Raaijmakers.

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Raaijmakers, R., Schröder, C., Monnens, L. et al. Fungal peritonitis in children on peritoneal dialysis. Pediatr Nephrol 22, 288–293 (2007). https://doi.org/10.1007/s00467-006-0289-x

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  • DOI: https://doi.org/10.1007/s00467-006-0289-x

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