Kunin Margarita, Tanasiychuk Tatiana, Abu-Amer Nabil, Soetendorp Hila, Einbinder Yael, Mini Sharon, Bnaya Alon, Kenig-Kozlovsky Yael, Golomb Yael, Gershkovitz Regina, Rosenberg Roza, Lev Netta, Abu-Sneineh Marwan, Goldman Shira, Levadev Larissa, Rubinchik Irina, Beckerman Pazit
Nephrology and Hypertension Institute, Sheba Medical Center and the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Department of Nephrology, Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel.
Eur J Clin Microbiol Infect Dis. 2025 Sep 18. doi: 10.1007/s10096-025-05259-6.
Fungal peritonitis is a rare but serious complication of peritoneal dialysis (PD), associated with high morbidity, mortality, and technique failure. This study aimed to evaluate the clinical course, risk factors, and outcomes of fungal peritonitis in adult PD patients.
We conducted a nationwide retrospective study including all cases of PD-associated fungal peritonitis identified over the past decade in medical centers across Israel. Clinical, microbiological, and outcome data were analyzed.
Forty patients were identified, with a median age of 72.5 years. The most common symptoms were abdominal pain and cloudy effluent. In 82.5% of cases, cultures grew Candida, most frequently Candida parapsilosis. During the peritonitis episode, 95% of patients required hospitalization, 90% underwent Tenckhoff catheter removal, and 27.5% died. Fluconazole was the most commonly used antifungal (80%). In the preceding three months, 55% of patients had bacterial peritonitis and 62.5% received two or more antibiotic types. Polymicrobial infections and Enterococcus species were common in preceding bacterial episodes. Compared to bacterial peritonitis cases, fungal peritonitis was associated with significantly higher rates of hospitalization (95% vs. 39.1%, p < 0.001), catheter removal (90% vs. 9.4%, p < 0.001), and permanent transfer to hemodialysis (67.5% vs. 3.1%, p < 0.001). Use of multiple antibiotics in the prior 3 months was independently associated with fungal peritonitis (OR 1.940, 95% CI 1.291-2.917; p = 0.001).
Fungal peritonitis in PD patients carries a poor prognosis. Recent bacterial peritonitis-particularly complicated cases such as polymicrobial or enteric-origin infections as well as recent exposure to multiple antibacterial agents, may serve as predisposing risk factors.
真菌性腹膜炎是腹膜透析（PD）一种罕见但严重的并发症，与高发病率、死亡率及技术失败相关。本研究旨在评估成年PD患者真菌性腹膜炎的临床病程、危险因素及预后。
我们开展了一项全国性回顾性研究，纳入了以色列各地医疗中心在过去十年中确诊的所有PD相关真菌性腹膜炎病例。对临床、微生物学及预后数据进行了分析。
共确定40例患者，中位年龄为72.5岁。最常见的症状是腹痛和腹水浑浊。在82.5%的病例中，培养出念珠菌，最常见的是近平滑念珠菌。在腹膜炎发作期间，95%的患者需要住院，90%的患者接受了Tenckhoff导管拔除，27.5%的患者死亡。氟康唑是最常用的抗真菌药物（80%）。在之前的三个月中，55%的患者发生过细菌性腹膜炎，62.5%的患者接受过两种或更多类型的抗生素治疗。多重微生物感染和肠球菌属在之前的细菌性发作中很常见。与细菌性腹膜炎病例相比，真菌性腹膜炎的住院率（95%对39.1%，p<0.001）、导管拔除率（90%对9.4%，p<0.001）及永久性转为血液透析率（67.5%对3.1%，p<0.001）显著更高。在之前3个月使用多种抗生素与真菌性腹膜炎独立相关（OR 1.940，95%CI 1.291 - 2.917；p = 0.001）。
PD患者的真菌性腹膜炎预后不良。近期的细菌性腹膜炎——特别是复杂病例，如多重微生物或肠道源性感染以及近期接触多种抗菌药物，可能是诱发危险因素。
