Munshi R, et al. - This investigation was implemented to describe the epidemiology of fungal peritonitis and outcomes of affected patients among pediatric subjects receiving chronic peritoneal dialysis (PD) and enrolled in Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE). Researchers noted that in the SCOPE collaborative, 8.0% of peritonitis episodes were attributed to fungal infections, the majority of these occurred in children aged < 2 years. Only young age was identified as risk factor for infection. In addition, fungal peritonitis was shown to be related to an increased risk of hospitalization, longer hospital stay and an increased frequency of technique failure.

Methods

• Between October 2011 and September 2015, researchers gathered data regarding PD characteristics, peritonitis episodes and patient outcome from 30 pediatric dialysis centers participating in the SCOPE collaborative.
• They stratified peritonitis-related data by etiology, fungal vs bacterial/culture-negative peritonitis.
• Using Chi-square analysis, they assessed the differences among groups.

Results

• In the registry, a total of 994 patients were enrolled, there were 511 peritonitis episodes of which 41 (8.0%) were fungal.
• Data reported that 36 individual patients with 39 unique catheters accounted for the fungal peritonitis episodes.
• The occurrence of 23 (59%) of the episodes was reported in patients aged < 2 years (p=0.03).
• Researchers observed that in 48.8% of affected patients, fungal peritonitis was the initial episode of peritonitis, and a previous peritonitis episode within 30 days of the fungal infection was reported in only 17.1% of these patients.
• They also noted that insertion of the PD catheter at < 2 years of age was related to an adjusted odds ratio of 2.8 (95% confidence interval 1.24, 6.31) for development of fungal peritonitis compared to older children (p=0.01).
• In addition, an increased rate of hospitalization (80.5 vs 63.4%; p=0.03), increased length of hospitalization (median of 8 vs 5 days; p < 0.001) and increased rates of catheter removal (84.6 vs 26.9%; p=0.001) and technique failure (68.3 vs 8%; p=0.001) were present in association with fungal peritonitis when compared to other causes of peritonitis.