Efficacy of topical treatment for fungal peritoneal dialysis exit-site infection (ESI)

Peritoneal dialysis exit site infections (ESIs) is a common complication among patients undergoing peritoneal dialysis (PD). Timely diagnosis and effective treatment are crucial, as they can lead to peritonitis and catheter removal. Although fungal ESIs are rare, they can be particularly harmful, and there are currently no formal recommendations for their management. Eighteen fungal ESI episodes were diagnosed in 11 patients who underwent continuous ambulatory peritoneal dialysis. All initially treated with topical clotrimazole. In 27.7%, oral antifungal therapy was added due to persistent infection. Overall, the treatment success rate was 94%. Importantly, none of the cases progressed and no PD catheters required removal. Fungal ESIs, while rare, can be life-threatening complications for PD patients. Our findings showed that topical antifungal therapy alone was successful in more than 70% of the cases. We achieved complete resolution of ESIs in all patients who completed treatment. Therefore, initial treatment with topical antifungal medication may be a valid approach, provided there is close monitoring. However, further studies are needed.