The Use of Fluconazole in the Management of Candida Peritonitis in Patients on Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 357-359 ◽  
Author(s):  
Brian S. Hoch ◽  
Neel K. Namboodiri ◽  
Geronimo Banayat ◽  
George Neiderman ◽  
Bertin M. Louis ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Microscopic Examination ◽  
Candida Species ◽  
Catheter Removal ◽  
Loading Dose ◽  
Fungal Peritonitis ◽  
Cell Counts ◽  
Fluconazole Therapy ◽  
Candida Peritonitis

In patients receiving peritoneal dialysis, fungal peritonitis is generally impossible to eradicate with previously available therapy in the absence of catheter removal. Corbella et al. described a patient with fungal peritonitis treated with fluconazole without catheter removal. We studied this drug's effectiveness in the treatment of 5 patients with peritonitis secondary to Candida species. Patients received a loading dose of 200–400 mg fluconazole, followed by 50–200 mg fluconazole daily. Patients Improved initially after therapy with fluconazole. Abdominal pain and fever abated, dialysis returns cleared, cell counts decreased, and, in four cases, cuitures were sterilized. Dialysate fluconazole levels were adequate. However, despite maintenance of fluconazole therapy, all patients had recurrent peritonitis within 1 month. Complete cure did not occur unless the Tenckhoff catheter was removed. When the catheter was removed, tip cuitures grew pure Candida species, and microscopic examination of catheter sections revealed abundant yeast. Although there may be continued isolated reports of successful eradication of fungal peritonitis without catheter removal, we conclude that in the vast majority of cases catheter removal is required.

Fungal Peritonitis in Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (3) ◽  
pp. 207-222 ◽  
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.

Early Catheter Removal Improves Patient Survival in Peritoneal Dialysis Patients with Fungal Peritonitis: Results of Ninety-Four Episodes of Fungal Peritonitis at a Single Center

2011 ◽  
Vol 31 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Tae Ik Chang ◽  
Hyun Wook Kim ◽  
Jung Tak Park ◽  
Dong Hyung Lee ◽  
Ju Hyun Lee ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Intestinal Obstruction ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Findings ◽  
Catheter Removal ◽  
High Morbidity ◽  
Fungal Peritonitis ◽  
Presenting Symptoms ◽  
Cell Counts

BackgroundFungal peritonitis (FP) is an uncommon but serious complication of peritoneal dialysis (PD) and is associated with high morbidity and mortality. Although previous studies have demonstrated that abdominal pain and catheter in situ are associated with mortality in FP patients, the effect of early catheter removal on mortality remains largely unexplored. In this study, therefore, we not only determine the risk factors for mortality but also investigate the effect of immediate catheter removal on mortality in PD patients with FP.Patients and MethodsThis retrospective study was conducted on 94 episodes of FP in 1926 patients that underwent PD at Yonsei University Health System from January 1992 to December 2008. Data including demographic characteristics, laboratory and clinical findings, management, and outcome were collected from medical records.ResultsAmong a total of 2361 episodes of peritonitis, there were 94 episodes of FP in 92 patients, which accounted for 4.0% of all peritonitis episodes and occurred in 4.8% of patients. Mean age of patients was 52.1 years and mean duration of PD before contracting FP was 46.1 months. The presenting symptoms included turbid dialysate (93.6%), abdominal pain (84.0%), and fever (66.0%). Intestinal obstruction was complicated in 39 episodes (41.5%). 75% of FP was caused by Candida species, among which Candida albicans was the most common pathogen, accounting for 41.5% of all episodes of FP. The PD catheter was removed within 24 hours in 39 patients (41.5%), whereas catheter removal was performed between 2 and 9 days after the diagnosis of FP in 42 patients (44.7%). 27 patients (28.7%) died as a result of FP, 59 patients (62.8%) required a change to hemodialysis, and PD was resumed in 8 episodes (8.5%). In addition, the mortality rate was significantly higher in patients with delayed catheter removal (13/41, 31.7%) compared to patients with catheter removal within 24 hours (5/39, 12.8%) ( p < 0.01). Multivariate logistic regression analysis revealed that delayed catheter removal, the presence of intestinal obstruction, and higher white blood cell counts in the blood and in the PD effluent were independently associated with mortality in FP patients.ConclusionThese results suggest that immediate catheter removal ( i.e., within 24 hours after the diagnosis of FP) is mandatory in PD patients with FP.

Exserohilum Peritonitis in Peritoneal Dialysis in Northern China: A Case Report

2019 ◽  
Vol 39 (2) ◽  
pp. 175-176
Author(s):  
Yan Liu ◽  
Wenjing Gong ◽  
Yanming Yu ◽  
Lihua Jiang
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Candida Species ◽  
Rare Case ◽  
Northern China ◽  
Catheter Removal ◽  
Fungal Peritonitis ◽  
Anti Fungal

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.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium

2021 ◽  
Vol 14 (3) ◽  
pp. e240272
Author(s):  
Rita Calça ◽  
Francisca Gomes da Silva ◽  
Ana Rita Martins ◽  
Patrícia Quadros Branco
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Course ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Microbial Agents

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

Fungal Peritonitis

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.

Salvage of the peritoneal dialysis catheter in Candida peritonitis using amphotericin B catheter lock

2020 ◽  
pp. 089686082092323
Author(s):  
Anita van Eck van der Sluijs ◽  
Kamal ZAJ Eekelschot ◽  
Florine NJ Frakking ◽  
Pieter-Jan A Haas ◽  
Walther H Boer ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Catheter Removal ◽  
Late Relapse ◽  
Peritoneal Dialysis Catheter ◽  
Efficacy And Safety ◽  
Single Centre ◽  
Single Centre Study ◽  
Catheter Lock ◽  
Candida Peritonitis

Candida species form biofilms, facilitating adherence to peritoneal dialysis (PD) catheters and making them less susceptible to antifungal therapy. Therefore, the International Society for Peritoneal Dialysis recommends immediate PD catheter removal in case of Candida peritonitis. However, in 2007, our institution showed that Candida peritonitis could be successfully treated without catheter removal with a treatment strategy including amphotericin B as catheter lock. To confirm the efficacy and safety of this lock-based protocol, we evaluated the outcome of Candida peritonitis episodes since then. A retrospective, single-centre study was conducted in which we analysed all Candida peritonitis episodes in PD patients, treated with the lock-based protocol between July 2006 and March 2018. Eleven non-relapse Candida peritonitis episodes in 10 patients were treated with the lock-based protocol. Seven of the 11 episodes (64%) were cured without PD catheter removal (5 episodes cured immediately, 1 episode cured after an early relapse and 1 episode cured after a late relapse), in 2 episodes (18%) the catheter had to be removed, and two patients died (18%). This study confirms our previous findings that an amphotericin B lock-based protocol has potential to cure Candida peritonitis without PD catheter removal. However, further research is needed given the limitations of this study. Until that time, the lock-based Candida protocol could be used in patients who are not severely ill and in whom PD catheter removal is not desirable.

scholarly journals Frequency and Antimicrobial Susceptibility of Bacterial Agents Causing Peritoneal Dialysis-Related Peritonitis: A Two-Center Experience

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Fariba Shirvani ◽  
Nakysa Hooman ◽  
Abdollah Karimi ◽  
Shahnaz Armin ◽  
Alireza Fahimzad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Therapeutic Option ◽  
Intraperitoneal Administration ◽  
Clinical Manifestations ◽  
Empiric Therapy ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Oxacillin Resistance ◽  
Gram Negative Organisms

Background: Peritonitis remains a significant complication of peritoneal dialysis (PD) in children. Objectives: The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance. Methods: The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed. Results: A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains. Conclusions: PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

scholarly journals Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Rongrong Li ◽  
Difei Zhang ◽  
Jingwen He ◽  
Jianjun Ou ◽  
La Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Peritoneal Dialysis ◽  
Serum Potassium ◽  
Case Control Study ◽  
Case Control ◽  
Catheter Removal ◽  
Multivariate Logistic Regression ◽  
Fungal Peritonitis ◽  
Control Study

Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak.Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP.Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P &lt; 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P &lt; 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P &lt; 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P &lt; 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P &lt; 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P &lt; 0.01) were significantly increased the risk for FP.Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.

Fungal Eosinophilic Peritonitis Due to AL Ternaria in a Patient on Continuous Ambulatory Peritoneal Dialysis

1984 ◽  
Vol 4 (4) ◽  
pp. 255-256 ◽  
Author(s):  
Jean-Daniel Horisberger ◽  
Jacques Bille ◽  
Jean-Pierre Wauters
Keyword(s):  
Peritoneal Dialysis ◽  
Filamentous Fungus ◽  
Alternaria Alternata ◽  
Candida Species ◽  
Peritoneal Fluid ◽  
Fungus Infection ◽  
Fungal Peritonitis ◽  
Benign Condition ◽  
Alternaria Species ◽  
Catheter Implantation

We describe an unusual episode of fungal peritonitis, caused by an Alternaria species and associated with a persistent eosinophilia in peritoneal fluid and blood. Peritoneal and systemic eosinophilia, persisting long after catheter insertion and, associated with the signs of peritonitis, should arouse suspicion of a fungus infection. About 5% of episodes of peritonitis in patients on CAPD are due to yeast, mainly of the Candida species (I). On rare occasions, cases have been re ported of peritoneal infections in CAPD patients caused by various filamentous fungi (2 7). Peritoneal fluid eosinophilia in CAPD patients, a self-limited, benign condition, is a well described entity and usually occurs soon after catheter implantation (8–10). We present an episode of a fungal peritonitis, associated with a late, longstanding eosinophilia of peritoneal fluid and peripheral blood. The responsible organism was a dematiceous filamentous fungus identified as Alternaria alternata.

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