If PD effluent culture shows Candida or there is no improvement after 5 days of antibiotics, what is the recommended management?

• A. Continue the same regimen and reassess in 2 weeks
• B. Initiate antifungal therapy and evaluate for catheter removal
• C. Switch to oral antifungals only
• D. Discontinue all antifungal therapy and observe

Answer: (B)

Candida in the PD effluent indicates fungal peritonitis, a serious complication because fungi form biofilms on the catheter that antibiotics alone can't clear. The best approach is to start antifungal therapy promptly and assess whether the catheter should be removed. Antifungal treatment targets the organism, while removing the catheter eliminates the persistent source of infection and improves the chance of cure. After the infection is controlled, the patient can resume PD with a new catheter or switch to another dialysis modality if needed. Continuing the same antibiotics, using only oral antifungals, or stopping antifungal therapy would not effectively treat the infection.