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Fungal Peritonitis Mandatory Catheter Removal PD — ESENeph MCQ

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ModeratePeritoneal DialysisFungal Peritonitis Mandatory Catheter Removal PDESENeph

A 42-year-old woman on CAPD develops cloudy dialysate with abdominal pain. PD effluent WCC is 2500/mm3 with 95% neutrophils. Gram stain shows yeast forms. What is the mandatory management in addition to antifungal therapy?

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Correct answer: E — PD catheter removal within 24 hours

Fungal peritonitis in PD is an absolute indication for PD catheter removal within 24 hours of diagnosis per ISPD 2022 guidelines. Fungal peritonitis has high mortality (~25%) and extremely poor outcomes if treated with antifungals alone without catheter removal. The patient should be transferred to temporary haemodialysis. Antifungal therapy (fluconazole for Candida, amphotericin B/caspofungin for resistant species) should be started immediately alongside catheter removal. PD can potentially be resumed after a minimum 2-week antifungal course and 2-3 week rest period with new catheter insertion if PD is desired.

Reference: https://guidelines.ukkidney.org