RISK FACTORS OF DEVELOPMENT OF FUNGAL PERITONITIS AND ITS OUTCOME IN PATIENTS ON CONTINUOS AMBULATORY PERITONEAL DIALYSIS

Fungi are important causes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common causes of fungal peritonitis are Candida albicans or other Candida species.From January 1994 to October 1998 we treated 71 patients with CAPD (a total of 1319 months of treatment). There were 95 episodes of peritonitis (1 case of peritonitis for every 13.88 months of treatment). Four cases of peritonitis were due to a fungal etiology (1 case of peritonitis for every 329,75 months of treatment). Of the patients, three was male, 1 female. The mean age was 30.6, (range 22-54). Diagnosis was established by cultures of dialysis effluent. Of four patients, 2 were diabetic. Three of the patients had received multible antibiotics before the onset of the peritonitis because of either bacterial peritonitis or exit site infection. The cuff of the periton dialysis catheter was not intact in two patients. Serum albumin levels were lower than 3.5mg/dl in all patients before fungal peritonitis. The mean duration of CAPD before fungal peritonitis was 11 months (range 1-36 months). Candida albicans was determined in 2 patients, Acromonium strictum in 1, Candida gillermandi in 1. Our patients were treated with flucasonole/ and amphotericins B according to antibiyogram results. In all patients the catheter was removed. One patients died from sepsis during antifungal therapy.

It is suggested that, other systemic diseases and receiving antibiotics are at great risk of suffering from fungal peritonitis.