Ten-year experience with fungal peritonitis in peritoneal dialysis patients: antifungal susceptibility patterns in a North-American center

Int J Infect Dis. 2012 Jan;16(1):e41-3. doi: 10.1016/j.ijid.2011.09.016. Epub 2011 Nov 4.

Abstract

Objective: To describe the clinical and microbiological features associated with fungal peritonitis in peritoneal dialysis (PD) patients at Hôpital Maisonneuve-Rosemont, from August 1996 to July 2006.

Methods: Cases were retrieved from the microbiology laboratory culture registry. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute M27A3 method.

Results: Among 288 PD patients (total follow-up of 7258 patient-months), nine were found with fungal peritonitis. Candida spp were identified in all of them, with a majority of non-albicans Candida species. Resistance to fluconazole, itraconazole, or voriconazole was as frequent as potential resistance to amphotericin B. No isolate was resistant to caspofungin and one was resistant to micafungin. Prior bacterial peritonitis was frequent (67%). All patients had their PD catheter removed and all of them survived.

Conclusions: In our institution, fungal peritonitis in PD patients is rare. All cases were caused by Candida species. Variable susceptibility patterns were observed, which may influence the initial empirical antifungal therapy and underscore the importance of individual speciation and susceptibility testing of invasive Candida isolates.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use*
  • Candida / isolation & purification
  • Candida / pathogenicity
  • Caspofungin
  • Drug Resistance, Fungal*
  • Echinocandins / therapeutic use
  • Female
  • Fluconazole / therapeutic use
  • Follow-Up Studies
  • Humans
  • Itraconazole / therapeutic use
  • Lipopeptides / therapeutic use
  • Male
  • Micafungin
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mycoses / drug therapy
  • Mycoses / epidemiology*
  • Mycoses / etiology
  • North America / epidemiology
  • Peritoneal Dialysis / methods*
  • Peritonitis / complications
  • Peritonitis / drug therapy
  • Peritonitis / epidemiology*
  • Peritonitis / microbiology
  • Pyrimidines / therapeutic use
  • Triazoles / therapeutic use
  • Voriconazole

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Pyrimidines
  • Triazoles
  • Itraconazole
  • Amphotericin B
  • Fluconazole
  • Caspofungin
  • Voriconazole
  • Micafungin