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Spectrum of Fungal Infections in Continuous Ambulatory Peritoneal Dialysis: A 20-Year Retrospective Study From a Tertiary Care Center

Summary

This study examined fungal infections in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) over 20 years at an Indian medical center. Researchers found that yeast infections, particularly Candida tropicalis, were more common than mold infections, with Aspergillus flavus being the most frequent mold. The study identified several rare and emerging fungi causing these serious infections and tested their susceptibility to antifungal medications. Results show that removing the dialysis catheter combined with appropriate antifungal treatment is crucial for patient survival.

Background

Fungal peritonitis (FP) is a rare but severe complication in continuous ambulatory peritoneal dialysis (CAPD) patients with high mortality rates. Globally, FP ranges from 1% to 12%, while in India it reaches up to 24%. In recent decades, rare fungi have been identified as causative agents of FP, necessitating species-specific identification and antifungal susceptibility testing.

Objective

To analyze the spectrum of fungal pathogens causing CAPD peritonitis and their antifungal susceptibility patterns over a 20-year period. The study aimed to highlight emerging and rare fungi as etiologic agents and emphasize the necessity for species-specific antifungal susceptibility data to guide clinical management.

Results

Yeast was isolated in 65 (59%) samples and mold in 45 (41%) cases. Candida tropicalis was the most common yeast (30.7%), followed by Candida parapsilosis (24.6%). Aspergillus flavus was the most common mold (57.7%). Antifungal susceptibility data was available for 33 yeast isolates, with 81.8% susceptible to tested antifungals. Rare pathogens included Kodamaea ohmeri, Fereydounia khargensis, Rhodotorula glutinis, Simplicillium obclavatum, and Bipolaris hawaiiensis.

Conclusion

Candida species remain the most common pathogen causing CAPD fungal peritonitis, with a notable shift toward non-albicans Candida species. Emerging resistance in Trichosporon asahii and rare pathogens like Fereydounia khargensis highlights the importance of species-specific identification and antifungal susceptibility testing. Early catheter removal combined with appropriate antifungal therapy is essential for optimal patient outcomes.
  • Published in:Cureus,
  • Study Type:Retrospective Observational Study,
  • Source: PMID: 40984905, DOI: 10.7759/cureus.90652
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