Upma Narain and Arvind Gupta
Background: Fungal peritonitis represents one of the most serious complications in patients on Continuous Ambulatory Peritoneal Dialysis therapy. In the present study we have analyzed peritoneal dialysis patients who have developed Candida peritonitis.
Methods & Findings: In between January 2000 to August 2015, in our retrospective study we identified 65 episodes of peritoneal dialysis associated with fungal peritonitis, and examined their demographic features, predictors, incidence of Candida species and their outcome. Among 65 fungal episodes 89.3% were Candida species, 1.5% yeast and 9.2% were dimorphic fungi. Non-albicans Candida species outnumbered the Candida albicans. Significant association was found between predictors and pathogens. Previous bacterial peritonitis episode was strongest predictor amongst the all. On analyzing the outcome data obtained from all 65 patients through Chi test, we inferred that non-albicans Candida species were the major cause of death in majority of the patients. The similar trend was found in almost all the primary causes of End Stage renal disease test set, however the sample size (in others) was less than the minimum number of cases to be inferred statistically sound. The Loss of life parameters was found to be more than 3 fold higher in cases of non-albicans Candida species.
Conclusion: This study emphasizes that non-albicans Candida species appeared to be the significant pathogen in cases of Peritoneal Dialysis associated with fungal peritonitis. Hence, the study concludes that to reduce morbidity we need to start empirical antifungal coverage by taking into account their local epidemiological prevalence and their intrinsic behavior to antifungal drugs. Therefore to reduce mortality and chances of treatment failure we have to ensure rapid fungal species identification and risk assessment.