Fungal Peritonitis Mandatory Catheter Removal — ESENeph MCQ
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Correct answer: A — Remove the PD catheter and continue systemic antifungal therapy after removal
A is correct. ISPD recommends immediate catheter removal when fungi are identified in PD effluent, even when symptoms begin to improve on antifungal therapy. Fungal biofilm makes catheter salvage unreliable and delayed removal is associated with poor outcomes. An appropriate systemic antifungal is continued for at least two weeks after removal, guided by organism and susceptibility, with temporary haemodialysis usually required. Transfer-set exchange alone does not remove the infected intraperitoneal surface. Later return to PD is considered only after complete clinical resolution and an appropriate interval.
Reference: ISPD peritonitis guideline recommendations: 2022 update: https://journals.sagepub.com/doi/10.1177/08968608221080586