Topical Antifungal Therapy Achieves 94 Percent Success in Fungal PD Exit-Site Infections: Study
Spain: Fungal infections at the peritoneal dialysis (PD) catheter exit site, though uncommon, can pose serious risks for patients receiving long-term dialysis therapy. A new study published in BMC Nephrology reports that topical antifungal treatment may be an effective first-line option for managing these infections, potentially preventing severe complications such as peritonitis or catheter removal.
Peritoneal dialysis exit-site infections (ESIs) are among the most frequent complications in patients undergoing PD. If not promptly and adequately treated, these infections can extend along the catheter tunnel, leading to peritonitis and, in some cases, necessitating catheter removal and interruption of dialysis therapy. While bacterial ESIs are more common and have established treatment protocols, fungal ESIs are rare and lack clear management guidelines. Given their potential severity, identifying effective treatment strategies is essential.
R. Haridian Sosa Barrios, representing the Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) of the Spanish Society of Nephrology (SEN), Madrid, and colleagues evaluated the outcomes of topical antifungal therapy in patients with fungal ESIs. The study included 18 episodes of fungal exit-site infections diagnosed in 11 individuals receiving continuous ambulatory peritoneal dialysis.
Key Takeaways:
- All fungal exit-site infection cases were initially treated with topical clotrimazole applied directly to the affected area.
- In most episodes, topical therapy alone was sufficient to control the infection.
- Oral antifungal medication was added in approximately 27.7% of cases due to persistent symptoms or inadequate response to topical treatment.
- The overall treatment success rate across all episodes was 94%.
- None of the infections progressed to complications such as peritonitis.
- No patients required removal of their peritoneal dialysis catheter.
- Complete resolution of infection was achieved in all patients who completed the prescribed treatment.
The findings suggest that topical antifungal therapy alone can effectively manage most fungal ESIs, resolving more than 70% of cases without the need for systemic treatment. This approach may offer several advantages, including reduced exposure to systemic antifungal drugs and their potential adverse effects.
Despite the encouraging results, the authors caution that careful monitoring is essential when adopting a topical-only strategy. Early identification of non-responders remains critical to ensure timely escalation of therapy if needed. They also emphasize that larger studies are necessary to confirm these findings and to inform the development of formal clinical recommendations.
In summary, the study highlights a promising and less invasive treatment approach for a rare but potentially serious complication of peritoneal dialysis, offering reassurance that early, targeted topical therapy may be both safe and effective when combined with vigilant follow-up.
Reference:
Sosa Barrios, R.H., Piris González, M., Campillo Trapero, C. et al. Efficacy of topical treatment for fungal peritoneal dialysis exit-site infection (ESI). BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04868-3
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