Fungal Peritonitis in Peritoneal Dialysis: An 18-year Experience from Nizwa Hospital, Sultanate of Oman

Abstract Background: Peritoneal dialysis is an effective therapy for end-stage kidney disease patients. Fungal peritonitis is a rare complication in patients on peritoneal dialysis. Data on peritoneal dialysis-associated fungal peritonitis from Oman are lacking. Objective: To report the epidemiology, management practices, and outcomes in cases of peritoneal dialysis-associated fungal peritonitis from a tertiary hospital in Oman. Patients and Methods: This retrospective study included all patients aged ≥13 years who developed fungal peritonitis after peritoneal dialysis treatment at Nizwa Hospital, Nizwa City, Oman, between March 01, 2005, and March 31, 2023. Results: A total of 311 patients were followed-up for peritoneal dialysis during the study period, of which 10 patients developed peritoneal dialysis-related fungal peritonitis (3.2%) (males: 80%; mean age: 54.5 ± 19.9 years). Candida spp. accounted for 80% of the cases, with a predominance of non- Candida albicans spp., while Aspergillus accounted for the remaining 20%. Previous bacterial peritonitis was noted in seven patients (70%) treated with multiple antibiotics, while six patients (60%) had received antibiotics within the past 1 month. Therapeutic approach was immediate systemic antifungal and peritoneal dialysis catheter removal with transfer to hemodialysis. The mortality rate was 20%. Conclusions: About 3% of the patients on peritoneal dialysis at Nizwa Hospital, Oman, developed fungal peritonitis. Prior antibiotic use was a major risk factor, and thus antifungal prophylaxis is recommended. Candida spp. was the most common pathogen.