SP501EARLY CATHETER REMOVAL IMPROVES PATIENT SURVIVAL IN PERITONEAL DIALYSIS PATIENTS WITH FUNGAL PERITONITIS

Fungal peritonitis is a catastrophic complication of peritoneal dialysis (PD) and often requires termination of PD. It is usually caused by Candida species. Here we report a rare case of Exserohilum peritonitis. The patient was successfully treated with catheter removal and anti-fungal therapy.

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Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

Peritoneal Dialysis International ◽

10.1177/0896860819879891 ◽

2020 ◽

Vol 40 (1) ◽

pp. 47-56 ◽

Cited By ~ 1

Author(s):

Htay Htay ◽

Yeoungjee Cho ◽

Elaine M Pascoe ◽

Carmel Hawley ◽

Philip A Clayton ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Primary Outcome ◽

Catheter Removal ◽

Dialysis Patients ◽

Gram Positive ◽

Pseudomonas Species ◽

Gram Negative Organisms ◽

Culture Positive ◽

Culture Negative ◽

Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

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Fungal Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686088000100104 ◽

1980 ◽

Vol 1 (1) ◽

pp. 3-3

Keyword(s):

Peritoneal Dialysis ◽

Antifungal Agents ◽

Clinical Symptoms ◽

Bowel Perforation ◽

Catheter Removal ◽

Analgesic Nephropathy ◽

Chronic Glomerulonephritis ◽

Gram Stain ◽

Polycystic Kidney ◽

Fungal Peritonitis

R. Khanna, D.G. Oreopoulos, 8.1. Vas, W. McCready and N. Dombros (will be presented at the European Dialysis and Transplantation Association, Prague, June 1980) Ten patients with chronic renal failure on intermittent perito. neal dialysis (3) and CAPD (7) developed fungal peritonitis. Six were males and four females. Four had chronic glomerulonephritis, three had polycystic kidney disease and one each had chronic pyelonephritis, diabetes and analgesic nephropathy. Dialysate effluent was cloudy in all. Eight patients had clinical symptoms (abdominal pain, nausea and vomiting) and signs (abdominal tenderness with rebound and guarding and lowgrade fever). Initially, gram stain identified fungus in six of them, namely Candida (6), Fusarium (2), Mucor (1), Trichosporon (1). Nine patients were treated with continuous lavage with a dialysate containing appropriate antifungal agents (Amphotericin B, 5 mg/l, 5-Fluorocytosine 50 mg/l and Miconazole 10 mg/l) for a period of 2 to 15 days. Only two patients improved on this therapy. In six the dialysis catheter had to be removed before there was any clinical improvement. Indications for catheter removal were persistent positive effluent culture and clinical deterioration. Four patients returned to peritoneal dialysis (IPD 1, CAPD 3); four were transferred to hemodialysis. Two who had bowel perforation died. Fungal peritonitis is not infrequent in chronic peritoneal dia. lysis, especially in patients on CAPD. In most cases, clinical cure will require catheter removal and antifungal therapy. Following the infection, patients can he returned to peritoneal dialysis.

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Fungal Peritonitis in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080502500302 ◽

2005 ◽

Vol 25 (3) ◽

pp. 207-222 ◽

Cited By ~ 49

Author(s):

Narayan Prasad ◽

Amit Gupta

Keyword(s):

Abdominal Pain ◽

Peritoneal Dialysis ◽

Candida Species ◽

Fungal Infections ◽

Diagnostic Techniques ◽

Catheter Removal ◽

Prolonged Treatment ◽

Molecular Diagnostic ◽

Molecular Diagnostic Techniques ◽

Fungal Peritonitis

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% – 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often “nonpathogenic,” fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques ( e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 – 6 weeks.

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

Peritoneal Dialysis International ◽

10.1177/089686081103100201 ◽

2011 ◽

Vol 31 (2) ◽

pp. 120-120

Keyword(s):

Peritoneal Dialysis ◽

Randomized Control Trial ◽

Dialysis Patients ◽

Fungal Peritonitis ◽

Prospective Randomized Control Trial ◽

Randomized Control

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

Turkish Nephrology Dialysis Transplantation ◽

10.5262/tndt.2016.34 ◽

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

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

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00179 ◽

2015 ◽

Vol 35 (1) ◽

pp. 78-84 ◽

Cited By ~ 12

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.

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