Abstract: SA-PO704
Candida glabrata Fungal Peritonitis in a Peritoneal Dialysis Patient: A Case Report
Session Information
- Peritoneal Dialysis - II
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 608 Peritoneal Dialysis
Authors
- Emami, Sina, George Washington university, MClean, Virginia, United States
- Lew, Susie Q., George Washington University Medical Center, Washington, District of Columbia, United States
Background
Fungal peritonitis is a rare but serious complication in patients undergoing peritoneal dialysis (PD), and is associated with high morbidity and mortality. Fungal peritonitis accounts for 3% - 6% of all PD-associated peritonitis episodes.The most common cause of the disease is Candida, predominately C. albicans, and C. parapsilosis. C. glabrata peritonitis has not been reported in the United States.
The main factors associated with the development of fungal peritonitis include previous antibiotic therapy (particularly for bacterial peritonitis), fungal overgrowth in the gastrointestinal track, and declining peritoneal defenses because of peritonitis.
A major obstacle in C. glabrata infection treatment is their innate resistance to azole antimycotic therapy, which is very effective in eradicating infections caused by other Candida species.
Methods
A 74-year-old female with a history of diabetes, hypertension and end stage renal disease on peritoneal dialysis with multiple previous episodes of bacterial peritonitis presented with signs and symptoms typical of peritonitis. Empiric antibiotic therapy with intraperitoneal ceftriaxone and vancomycin was initiated to treat peritonitis. Following identification of yeast on the Gram stain, oral fluconazole therapy was started. The culture was identified as Candida glabrata resistant to fluconazole, itraconazole and voriconazole.
Oral fluconazole was switched to micafungin and the PD catheter was removed. Micafungin 100 mg IV every 24h was administered for a total 15 days. She transitioned to in-center HD. Although she wanted to return to PD, the team thought she was not a good candidate due to her age and home situation.
Conclusion
The approach to fungal peritonitis has changed considerably in recent years. The conventional antifungal regimens include fluconazole, amphotericin B, and flucytosine alone or in combination, optimally based on fungal sensitivities. Anti-fungal agents generally continue for at least 2 weeks after catheter removal.Observational studies suggest that prompt catheter removal probably improves outcome and reduces mortality.The newer agents such as caspofungin, micafungin and voriconazole have the potential to alter treatment strategies for fungal peritonitis, but further studies are required to clarify the precise role of these agents in this patient cohort.