Patients undergoing maintenance dialysis have a markedly increased incidence of fungal infection. A retrospective review of more than 300,000 patients in the United States Renal Data System (USRDS) from 1992 to 1997 demonstrated that dialysis patients had an age-adjusted incidence ratio for fungal infections of 9.8 compared with the general population . The vast majority of these fungal infections were due to Candida species (79 percent).
The majority of fungal infections in patients with end-stage renal disease (ESRD) are related to the technique of peritoneal dialysis (PD) .
Among patients undergoing PD, peritonitis resulting from fungi carries a higher morbidity and mortality than bacterial infections. Reported complications include sclerosing peritonitis, adhesions with resulting bowel obstructions or stricture, invasion of the bowel wall, and abscess formation . Extraperitoneal spread of infection is unusual, and mortality is usually related to underlying conditions.
An overview of fungal peritonitis in patients undergoing continuous PD is presented in this topic review. A general overview of peritonitis in PD is presented separately. (See "Microbiology and therapy of peritonitis in continuous peritoneal dialysis".)
Infections of the peritoneal space are the main complication of peritoneal dialysis (PD); they are usually caused by staphylococcal species. By comparison, fungi are responsible for 2 to 13 percent of such cases. Most fungal PD-associated infections are due to Candida species, especially C. albicans and C parapsilosis. Assorted molds and yeasts, such as species of Aspergillus , Fusarium, Rhodotorula, Mucorales, and dematiaceous molds, are occasionally observed. Fungi, when found with bacteria as part of a polymicrobial peritonitis, are a predictor of a poor response to therapy .