How is fungal peritonitis treated?
Fungal peritonitis is a serious disease that can lead to death in up to 25% of patients affected. Diagnosis either by microscopy or culture requires removal of the PD catheter, along with initiation of dual therapy with intravenous amphotericin B (dose adjusted to weight) and oral flucytosine 1000 mg/day. Given poor peritoneal penetration with intravenous use and chemical peritonitis with IP use, amphotericin should be replaced with another antifungal agent after fungal susceptibilities are determined. Most peritoneal fungal infections are a result of either Candida albicans or Candida parapsilosis , but can result from an assortment of fungi.
Recent antibiotic treatment has been shown to be a predisposing factor associated with subsequent development of fungal peritonitis. As such, antifungal prophylaxis is recommended for PD patients treated with a course of antibiotics, as per ISPD guidelines.
While fungal peritonitis is associated with a high frequency of technique failure, a third of patients were able to return to PD in a recent observational analysis.