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Fungal PD Peritonitis — RACP Adult Medicine MCQ

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ModerateNephrologyFungal PD PeritonitisRACP Adult Medicine

A 50-year-old man with chronic kidney disease on peritoneal dialysis develops cloudy effluent and abdominal pain. Effluent cell count shows WCC 2,500/µL (85% PMN). Gram stain shows yeast forms. What is the critical management step?

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Correct answer: C — Immediate PD catheter removal plus systemic antifungals

Fungal peritonitis in PD patients (most commonly Candida species) has a poor prognosis and REQUIRES immediate catheter removal combined with systemic antifungal therapy (fluconazole 200–400 mg daily or an echinocandin for 2–4 weeks after catheter removal). Attempts to treat fungal peritonitis without catheter removal have unacceptably high failure rates (>90%). After catheter removal, the patient transitions to haemodialysis temporarily. A new PD catheter can be reinserted 2–3 weeks after completing antifungal therapy and confirming resolution. ISPD 2022 guidelines are unequivocal on this point.

Reference: KHA-CARI – 2014 – PD Peritonitis; ISPD – 2022 – Peritonitis Guidelines