Fungal peritonitis in peritoneal dialysis patients: a nationwide cohort study.

Background: Fungal peritonitis is a rare but serious complication of peritoneal dialysis (PD), associated with high morbidity, mortality, and technique failure. This study aimed to evaluate the clinical course, risk factors, and outcomes of fungal peritonitis in adult PD patients.

Methods: We conducted a nationwide retrospective study including all cases of PD-associated fungal peritonitis identified over the past decade in medical centers across Israel. Clinical, microbiological, and outcome data were analyzed.

Results: Forty patients were identified, with a median age of 72.5 years. The most common symptoms were abdominal pain and cloudy effluent. In 82.5% of cases, cultures grew Candida, most frequently Candida parapsilosis. During the peritonitis episode, 95% of patients required hospitalization, 90% underwent Tenckhoff catheter removal, and 27.5% died. Fluconazole was the most commonly used antifungal (80%). In the preceding three months, 55% of patients had bacterial peritonitis and 62.5% received two or more antibiotic types. Polymicrobial infections and Enterococcus species were common in preceding bacterial episodes. Compared to bacterial peritonitis cases, fungal peritonitis was associated with significantly higher rates of hospitalization (95% vs. 39.1%, p < 0.001), catheter removal (90% vs. 9.4%, p < 0.001), and permanent transfer to hemodialysis (67.5% vs. 3.1%, p < 0.001). Use of multiple antibiotics in the prior 3 months was independently associated with fungal peritonitis (OR 1.940, 95% CI 1.291-2.917; p = 0.001).

Conclusions: Fungal peritonitis in PD patients carries a poor prognosis. Recent bacterial peritonitis-particularly complicated cases such as polymicrobial or enteric-origin infections as well as recent exposure to multiple antibacterial agents, may serve as predisposing risk factors.