Changing Pattern of Peritoneal Dialysis-Related Fungal Peritonitis: A 21-Year Single-Center Experience.

RATIONALE &

OBJECTIVE

Fungal peritonitis (FP) in peritoneal dialysis is rare but associated with catastrophic outcomes. This study evaluated the longitudinal evolution of FP incidence during 2004-2024, with particular interest in the effects of antifungal prophylaxis, which was introduced in 2016, on the development of FP and the risk factors for FP-associated death.

STUDY

DESIGN

Retrospective cohort study.

SETTING &

PARTICIPANTS

Sixty-two episodes of FP in 62 patients undergoing peritoneal dialysis who experienced FP at our center between January 2004 and December 2024.

EXPOSURE: Antifungal prophylaxis with oral fluconazole 100 mg/d.

OUTCOMES: Incidences of overall, secondary, and primary FP; risk factors for FP-associated death.

ANALYTICAL APPROACH: Linear by linear association; Poisson regression; logistic regression.

RESULTS

The average FP rate was 0.0065 episodes/patient-year. The annual FP rates significantly decreased over the 21 years (P = 0.019). The secondary FP rate declined from 0.0052 episodes/patient-year during 2004-2015 to 0.0022 episodes/patient-year during 2016-2024 (P = 0.016), while the primary FP rate remained stable (0.0035 episodes/patient-year during 2004-2015 vs 0.0036 episodes/patient-year during 2016-2024, P = 0.943). The proportion of primary FP increased from 39% before 2016 to 62% afterward (P = 0.078). Multivariable analysis showed that a higher Charlson comorbidity index (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.10-2.74) was associated with FP-associated death, while Candida parapsilosis as the sole causative fungus (OR, 0.17; 95% CI, 0.03-0.94) was associated with a lower risk of mortality.

LIMITATIONS: Single-center, observational study.

CONCLUSIONS

Incidences of overall FP and secondary FP declined at our center, advocating the effectiveness of antifungal prophylaxis in programs with a low baseline FP rate. Primary FP represented the major subtype after implementation of antifungal prophylaxis, and high mortality remained an issue. A greater comorbid condition burden, as well as certain species of causative fungi, were associated with risks of death.