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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 a major Indian hospital. Researchers identified various fungal species causing peritonitis, with Candida species being most common, but discovered increasingly rare fungi involved in these infections. The study found that proper identification of the specific fungus and testing for drug resistance is crucial for effective treatment, typically involving catheter removal and targeted antifungal medications.

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 1-12%, while in India it reaches 24%. Over recent decades, rare fungi have been increasingly identified as causative agents of FP.

Objective

To analyze the spectrum of fungal pathogens causing CAPD peritonitis and their antifungal susceptibility patterns over a 20-year period at a tertiary care center. The study emphasizes emerging and rare fungi and the necessity for species-specific antifungal susceptibility data.

Results

139 CAPD samples from 110 patients were analyzed. Yeasts were isolated in 65 samples (59%), with Candida tropicalis most common (30.7%), followed by C. parapsilosis (24.6%). Molds were isolated in 45 samples (41%), with Aspergillus flavus predominant (57.7%). Rare pathogens including Fereydounia khargensis, Kodamaea ohmeri, and Simplicillium obclavatum were identified.

Conclusion

Candida species remain the most common pathogen, but non-albicans species are increasingly prevalent. Identification of fungal species and antifungal susceptibility patterns are critical for appropriate management. Early catheter removal and species-specific antifungal therapy are essential for improving outcomes in CAPD fungal peritonitis.
  • Published in:Cureus,
  • Study Type:Retrospective Observational Study,
  • Source: PMID: 40984905, DOI: 10.7759/cureus.90652
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