Candida Albicans Peritoneal Infection In A Patient With Sclerosing Encapsulating Peritonitis Under Continuous Peritoneal Dialysis. Efficacy Of Intra-Abdominal Amphotericin B And Negative Pressure After Failure Of A Systemic Therapy.

Fungal peritonitis related to peritoneal dialysis contributes significantly to morbidity and to a high level of mortality. Up to now, there have not been any studies clearly demonstrating which treatment regimen has the best outcome in this kind of patients.Case Report: A 33-year-old man, under continuous ambulatory peritoneal dialysis, was admitted to our department with suspected infective peritonitis. Culture results of peritoneal lavage showed growing of Enterococcus faecalis and colonies of Candida albicans. We decided to immediately explore the abdomen, to remove the peritoneal dialysis catheter and to administer intravenous fluconazole and amphotericin B. Despite 30 days of intravenous combined-antibiotic therapy, cultures were still positives for Candida albicans . Peritoneal washing with amphotericin B and vacuum-assisted abdominal system were started and after 12 cycles we achieved the eradication of Candida. Discussion: Up to 80% of fungal peritonitis in patients on peritoneal dialysis are caused by candida. Catheter removal and prompt initiation of antifungal therapy are indicated; subsequent therapy is based upon culture results, sensitivity, and patient response. Vacuum-assisted wound closure has become the preferred treatment modality for many complex/chronic wounds and the topical negative pressure demonstrated a positive contribution also in managing severe peritonitis.Conclusions: Peritoneal sclerosis can negatively affect results of an intravenous antifungal therapy. Amphotericin B intraperitoneal lavages associated with topical negative abdominal pressure can represent an effective option for common therapy-resistant peritonitis.