Re-intubation after extubation of peritoneal dialysis catheter in one case of peritoneal dialysis-related filamentous fungal peritonitis and review of literature

Objective To study the diagnosis and treatment of peritoneal dialysis-related fungal peritonitis and its prognosis, combined with literature review, to strengthen the understanding of diagnosis and treatment of this disease.Methods We retrospectively analyzed the data of one case of peritoneal dialysis-related filamentous fungal peritonitis in the 117 th Hospital of PLA and reviewed the relevant literatures.Results A woman with diabetes receiving continuous ambulatory peritoneal dialysis (CAPD) was given ceftazidime combined with cefazolin in the emergence of peritoneal dialysis-related symptoms of peritonitis for 15 days, and there was no significant improvement in symptoms. The antibiotics were immediately withdrawn, the peritoneal dialysis tube was removed, and fluconazole was used when filamentous fungus was identified in peritoneal dialysis solution. The cheese-like substance in the intraperitoneal dialysis tube was cultured, and filamentous fungal growth was seen. Hemodialysis was performed after extubation. Six months later, the peritoneal dialysis catheter was re-intubated to do CAPD with 1.5% peritoneal dialysis fluid (4 times a day). Two weeks later, urine volume was 650 mL, ultrafiltration volume was -490 mL, residual kidney Kt/V was 0.811, peritoneal Kt/V was 1.832, total Kt/V was 2.64/week, residual kidney CCR was 35.7, peritoneal CCR was 38.9, total CCR was 74.6/week, and nPNAL was 1.12. PET test showed high average transport type. There was no severe symptom and patient was in good condition in the following 3 years. Repeated bacterial peritonitis occurred due to un-standardized aseptic operation. Then diagnosis of peritoneal ultrafiltration failure was made. Hemodialysis was given till now.Conclusions The main method of treating peritoneal dialysis-related filamentous fungal peritonitis is to withdraw peritoneal dialysis after extubation, however, when the peritonitis cured and the patient is in good condition, you can still consider re-intubation peritoneal dialysis catheter.