Abstract
Peritonitis and exit-site infections are important complications in peritoneal dialysis (PD) patients that are occasionally caused by opportunistic fungi inhabiting distant body sites. In this study, the oral yeast colonization of PD patients and the antifungal susceptibility profile of the isolated yeasts were accessed and correlated with fungal infection episodes in the following 4 years. Saliva yeast colonization was accessed in 21 PD patients and 27 healthy controls by growth in CHROMagar-Candida® and 18S rRNA/ITS sequencing. PD patients presented a lower oral yeast prevalence when compared to controls, namely, Candida albicans. Other species were also isolated, Candida glabrata and Candida carpophila. The antifungal susceptibility profiles of these isolates revealed resistance to itraconazole, variable susceptibility to caspofungin, and higher MIC values of posaconazole compared to previous reports. The 4-year longitudinal evaluation of these patients revealed Candida parapsilosis and Candida zeylanoides as PD-related exit-site infectious agents, but no correlation was found with oral yeast colonization. This pilot study suggests that oral yeast colonization may represent a limited risk for fungal infection development in PD patients. Oral yeast isolates presented a variable antifungal susceptibility profile, which may suggest resistance to some second-line drugs, highlighting the importance of antifungal susceptibility assessment in the clinical practice.
Highlights
Peritoneal dialysis (PD) is a home-based and widely used renal replacement therapy for patients with end-stage renal disease (ESRD)
PD patients presented a lower prevalence of yeasts in saliva compared to the healthy controls; the difference did not attain statistical signi cance (Table 3). ree Candida species were identi ed, namely, C. albicans and C. glabrata in PD patients and C. albicans and C. carpophila in controls. e prevalence of C. albicans was signi cantly lower in PD patients than in controls
Oral yeast colonization constitutes a limited risk for fungal infections in PD patients, due to the lack of relationship between fungal oral colonizers and PD infectious agents
Summary
Peritoneal dialysis (PD) is a home-based and widely used renal replacement therapy for patients with end-stage renal disease (ESRD). In PD patients, infectious complications, namely, peritonitis and exit-site infections, account for a signi cant percentage of catheter loss, transfer to haemodialysis, prolonged hospitalization, or even death, making prevention of infection a critical step to the success of a PD program [1]. Fungal peritonitis is associated with signi cant morbidity and mortality in PD patients [2]. Fungal exit-site infections are more frequent than peritonitis, but more resolved, they may potentiate the development of a subsequent peritonitis [3]. In a recent study where fungal exit-site infections of PD patients were evaluated, the most frequently isolated species were Candida parapsilosis (67%), followed by Candida glabrata (10%), Candida famata (7%), and Candida zeylanoides (7%) [4]
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Schedule a callMore From: The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale
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