Does Antifungal Prophylaxis with Daily Oral Fluconazole Reduce the Risk of Fungal Peritonitis in Peritoneal Dialysis Patients? The Pan Thames Renal Audit

2011 ◽  
Vol 32 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Andrew Davenport ◽  
David Wellsted
Keyword(s):  
Peritoneal Dialysis ◽  
Antifungal Prophylaxis ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Oral Fluconazole

scholarly journals THE RISK FACTORS AND OUTCOME OF FUNGAL PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

2009 ◽  
Vol 27 (1) ◽  
pp. 59-61
Author(s):  
E Indhumathi ◽  
V Chandrasekaran ◽  
D Jagadeswaran ◽  
M Varadarajan ◽  
G Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Fungal Peritonitis

Concurrent Fungal Peritonitis in Two Sibling Peritoneal Dialysis Patients: Case Report

2016 ◽  
Vol 25 ◽  
Author(s):  
Tuğba Yılmaz ◽  
Orçun Altunören ◽  
Didem Atay ◽  
Safa Ganidağlı ◽  
Elif İnanç ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Dialysis Patients ◽  
Fungal Peritonitis

scholarly journals Characteristics and Outcomes of Fungal Peritonitis in a Modern North American Cohort

2015 ◽  
Vol 35 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Annie-Claire Nadeau-Fredette ◽  
Joanne M Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
North American ◽  
Significant Proportion ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Risk Of Death ◽  
Dialysis Vintage ◽  
Unit Increase ◽  
Wbc Count ◽  
Technique Failure

IntroductionPeritonitis remains a common complication of peritoneal dialysis (PD). Although representing only 1 – 12% of overall peritonitis in dialysis patients, fungal peritonitis (FP) is associated with serious complications, including technique failure and death. Only scarce data have been published regarding FP outcomes in modern cohorts in North America. In this study we evaluated the rates, characteristics and outcomes of FP in a major North American PD center.MethodsWe conducted a retrospective cohort study including all fungal peritonitis episodes among peritoneal dialysis patients followed in a large PD center between January 2000 and February 2013. Our pre-specified end-points included rates of FP, characteristics, outcomes and determinants of death.ResultsThirty-six episodes of FP were identified during the follow-up period (one episode per 671 patient-months), representing 4.5% of the total peritonitis events. Patients’ mean age and peritoneal dialysis vintage were 61.3 ± 15.5 and 2.9 (1.5 – 4.8) years, respectively. Of the 36 episodes of FP, seven (19%) resulted in death and 17 (47%) led to technique failure with permanent transfer to hemodialysis. Surprisingly, PD was eventually resumed in 33% of cases with a median delay of 15 weeks (interquartile range 8 – 23) between FP and catheter reinsertion. In a univariable analysis, a higher Charlson comorbidity index (Odds ratio [OR] 3.25 per unit increase, 95% confidence interval [CI] 1.23 – 8.58) and PD fluid white blood cell (WBC) count greater than 3,000/mm3at presentation (OR 6.56, 95% CI 1.05 – 40.95) predicted death.ConclusionWhile fungal peritonitis is still associated with a high frequency of death and technique failure, one-third of our patients eventually returned to PD. Patients with a high burden of comorbidities appear at higher risk of death. We postulate that the high mortality associated with FP is partially related to the severity of comorbidity among patients with F P, rather than the infection per se. Importantly, PD can be resumed in a significant proportion of cases.

scholarly journals Ten-year experience with fungal peritonitis in peritoneal dialysis patients: antifungal susceptibility patterns in a North-American center

2012 ◽  
Vol 16 (1) ◽  
pp. e41-e43 ◽  
Author(s):  
Jasmin Levallois ◽  
Annie-Claire Nadeau-Fredette ◽  
Annie-Claude Labbé ◽  
Michel Laverdière ◽  
Denis Ouimet ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
North American ◽  
Antifungal Susceptibility ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Susceptibility Patterns

Fungal Peritonitis in Peritoneal Dialysis Patients: Successful Prophylaxis with Fluconazole, as Demonstrated by Prospective Randomized Control Trial

2010 ◽  
Vol 30 (6) ◽  
pp. 619-625 ◽  
Author(s):  
César Restrepo ◽  
Jose Chacon ◽  
Gilberto Manjarres
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Oral Antibiotic ◽  
Peritoneal Fibrosis ◽  
Exit Site Infection ◽  
Fungal Peritonitis ◽  
Oral Fluconazole ◽  
Bacterial Peritonitis ◽  
Significant Difference

ObjectivesTo determine whether oral administration of the antifungal fluconazole during the entire period of treatment of bacterial peritonitis (BP), exit-site infection (ESI), or tunnel infection (TI) prevents later appearance of fungal peritonitis (called secondary) in patients with chronic kidney disease stage 5 in a peritoneal dialysis (PD) program.Patients and MethodsAll patients treated in the PD program in RTS Ltda Sucursal Caldas, during the period 1 June 2004 to 30 October 2007 were screened. Patients that had infectious bacterial complications (BP, ESI, TI) were included in a prospective randomized trial to receive or not receive oral fluconazole (200 mg every 48 hours) throughout the time period required by the administration of therapeutic antibiotics via any route. It was evaluated whether the fungal peritonitis complication appeared within 30 – 150 days following the end of antibacterial treatment. Based on local results, the sample size necessary to obtain statistically significant results was determined to be 434 episodes of peritonitis.ResultsThe 434 episodes of peritonitis presented between the previously specified dates and during this same period there were 174 ESI or TI, of which only 52 received oral antibiotic treatment. Information in relation to consumption of antibiotics for purposes other than BP, ESI, and TI was not reliable and thus this variable was excluded. Among the episodes of peritonitis, 402 (92.6%) were of bacterial origin and 32 (7.3%) were mycotic, mainly Candida species [30 (93.75%)]. Of the fungal peritonitis, 14 (43.73%) were primary (without prior use of antibiotics) and 18 (56.25%) were secondary. In the group of patients that received prophylaxis with fluconazole (210 for BP and 26 for ESI or TI), only 3 occurrences of fungal peritonitis were observed within 30 – 150 days of its administration, which is opposite to the group without prophylaxis (210 for BP and 26 for ESI or TI), in which 15 occurrences of fungal peritonitis were detected. Statistical analysis of the group of patients with BP found comparisons of the proportions of those receiving fluconazole (0.92%) or not (6.45%) presented a highly significant difference in favor of prophylaxis ( p = 0.0051, Z = 2.8021). Given that only 1 patient in each group with ESI or TI, with or without prophylaxis, presented the complication fungal peritonitis, it was concluded that this result was not statistically significant. During laparoscopic surgery attempting reintroduction of the peritoneal catheter, it was found that 11 patients had severe adhesions or peritoneal fibrosis leading to obliteration of the peritoneal cavity. In 19 patients, reintroduction of the catheter was possible and the patients returned to PD without consequence.ConclusionIn patients with bacterial peritonitis, administration of prophylactic oral fluconazole throughout the time they received antibiotics significantly prevented the appearance of secondary fungal peritonitis.

scholarly journals Fungal peritonitis in peritoneal dialysis patients: is previous antibiotic therapy an essential condition?

Mycoses ◽  
2007 ◽  
Vol 50 (1) ◽  
pp. 79-81 ◽  
Author(s):  
Nuno Guimarães Rosa ◽  
Sónia Silva ◽  
José António Lopes ◽  
Patrícia Branco ◽  
Edgar de Almeida ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Essential Condition

scholarly journals Predictors and outcomes of fungal peritonitis in peritoneal dialysis patients

2009 ◽  
Vol 76 (6) ◽  
pp. 622-628 ◽  
Author(s):  
Rhianna Miles ◽  
Carmel M. Hawley ◽  
Stephen P. McDonald ◽  
Fiona G. Brown ◽  
Johan B. Rosman ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Fungal Peritonitis
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