Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre
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RESEARCH ARTICLE
Open Access
Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre Mohammed Alsuhaibani1,2*, Egab Aldosari3, Khawla A. Rahim4, Saeed Alzabli4 and Dayel Alshahrani2
Abstract Background: Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia. Methods: In this case–control study, the medical records and laboratory results of paediatric patients aged 0–14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio). Results: A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole. Conclusions: This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD. Keywords: Peritoneal, Nephrotic, Candida, Catheter, Dialysis, Fungal
Background Peritoneal dialysis (PD) is the best procedure for children with end-stage renal disease. Peritonitis is the most common complication in patients on PD, with a higher frequency in children than in adults, and it is the most frequent cause of treatment failure and mortality in patients on PD [1, 2]. The causative pathogens and patient susceptibility to PD-related peritonitis vary from time to time and from * Correspondence: [email protected] 1 Department of Paediatrics, College of Medicine, Qassim University, P.O. Box 6666, Buraidah, Qassim 51452, Saudi Arabia 2 Department of Paediatric Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia Full list of author information is available at the end of the article
region to region; hence, the International Society for Peritoneal Dialysis (ISPD) endorses the use of empirical antimicrobial medication to treat PD-related peritonitis depending on the region [3]. In children, PD-related bacterial peritonitis is the most frequently identified form of peritonitis, while peritonitis caused by fungal organisms account for 2–12.9% of all cases. PD-related fungal peritonitis (FP) has a higher morb
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