Management of Acremonium Peritonitis in Peritoneal Dialysis

Immediate Management Steps

The International Society of Peritoneal Dialysis recommends removing the peritoneal dialysis catheter immediately and initiating systemic antifungal therapy with voriconazole as first-line treatment, or alternatively amphotericin B or posaconazole 1
Catheter removal is almost always necessary for successful treatment of fungal peritonitis, including Acremonium species, and should be done promptly upon diagnosis 2
Wait at least 2 weeks after catheter removal before placing a new catheter to allow adequate treatment and resolution of infection 2, 3

Voriconazole is the recommended first-line agent for Acremonium infections based on clinical outcomes, according to the Infectious Diseases Society of America 1
Alternative agents include amphotericin B or posaconazole if voriconazole is contraindicated or unavailable, as suggested by the Clinical Microbiology and Infection guidelines 1
Acremonium species demonstrate variable in vitro susceptibility, with recent studies showing high MICs for most agents except terbinafine, highlighting the importance of antifungal stewardship 1

Continue systemic antifungal therapy for 2-3 weeks, guided by clinical response, as recommended by the Praxis Medical Insights 2, 3
Monitor for resolution of symptoms including clearing of dialysate, resolution of abdominal pain, and normalization of inflammatory markers 2

Acremonium grows slowly in culture; incubate plates for at least 2 weeks to avoid false-negative results, as advised by the Clinical Microbiology and Infection guidelines 1
Do not use aminoglycosides if residual renal function exists, as these agents cause nephrotoxicity and compromise residual function, which is crucial for outcomes, according to the Praxis Medical Insights 2

Surgery for infected tissue removal may be necessary if there is evidence of osteomyelitis, septic arthritis, or progressive infection despite medical therapy, as suggested by the Clinical Microbiology and Infection guidelines 1
Consider surgical debridement if infection extends beyond the peritoneum, as recommended by the Clinical Microbiology and Infection guidelines 1

Fungal peritonitis carries mortality rates exceeding 50% in some series, though Acremonium-specific mortality data are limited, highlighting the need for aggressive management, according to the Critical Care guidelines 4, 5