Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre

Abstract Background Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia. Methods In this case–control study, the medical records and laboratory results of paediatric patients aged 0–14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio). Results A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole. Conclusions This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.

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Clinical Features and Risk Factors of Fungal Peritonitis in Children on Peritoneal Dialysis

Frontiers in Pediatrics ◽

10.3389/fped.2021.683992 ◽

2021 ◽

Vol 9 ◽

Author(s):

Xiaoyan Fang ◽

Jingyi Cui ◽

Yihui Zhai ◽

Jiaojiao Liu ◽

Jia Rao ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Rare Complication ◽

Univariate Analysis ◽

Clinical Manifestations ◽

Antibiotic Use ◽

Fungal Peritonitis ◽

Bacterial Peritonitis

Objective: To analyse the clinical manifestations, aetiology, prognosis, and risk factors of fungal peritonitis (FP) in children on peritoneal dialysis (PD).Methods: Among 322 children undergoing PD at Children's Hospital of Fudan University, between January 2001 and December 2019, FP cases were retrospectively analysed and compared with those of bacterial peritonitis (BP) to analyse the risk factors of FP.Results: A total of 124 cases of peritonitis were treated, including 11 FP cases in 11 children (0.0019 episodes/patient*month) and 113 BP cases in 64 children (0.02 episodes/patient*month). Among the 11 FP cases, 7 cases (63.64%) were caused by Candida and Candida parapsilosis (5/7) was the most common pathogen of Candida. All FP patients were converted to haemodialysis (HD) and did not resume PD during follow-up. Two patients (18.2%) died after 6 months of HD due to heart failure, 2 patients underwent kidney transplant after 2 years of infection, and the other 7 patients were still on HD. The univariate analysis showed the usage rate of antibiotics in the month before the onset of peritonitis was higher (45.45 vs. 15.93%) and the mean serum albumin was lower (31.4 vs. 34.4 g/L) in the FP group when compared with BP group (P < 0.05), while multivariate analysis showed that serum albumin ≤ 30 g/L was an independent risk factor for FP (odds ratio 4.896, 95% confidence interval 1.335–17.961).Conclusion: FP is a rare complication of PD in children, but it is associated with high technique failure. Attention should be paid to hypoproteinaemia and antibiotic use in children on PD.

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Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080202200306 ◽

2002 ◽

Vol 22 (3) ◽

pp. 335-338 ◽

Cited By ~ 14

Author(s):

Robert E. Ariano ◽

Christine Franczuk ◽

Adrian Fine ◽

Godfrey K.M. Harding ◽

Sheryl A. Zelenitsky

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Methicillin Resistance ◽

Tertiary Care ◽

Significant Risk ◽

Response Rates ◽

Care Hospital ◽

Clinical Failure ◽

Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

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

Frontiers in Medicine ◽

10.3389/fmed.2021.774946 ◽

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 < 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 < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 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.

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Fungal Peritonitis in Peritoneal Dialysis: Our Experience and Review of Treatments

Peritoneal Dialysis International ◽

10.1177/089686088400400205 ◽

1984 ◽

Vol 4 (2) ◽

pp. 75-77 ◽

Cited By ~ 23

Author(s):

Aldo Fabris ◽

Stefano Biasioli ◽

Donata Borin ◽

Alessandra Brendolan ◽

Stefano Chiaramonte ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Antibiotic Treatment ◽

Clinical Manifestations ◽

Chronic Peritoneal Dialysis ◽

Subsequent Increase ◽

Fungal Peritonitis ◽

Bacterial Peritonitis ◽

Mycological Diagnosis ◽

Candida Sepsis ◽

Additional Therapy

From January 1975 to April 1982, 10 of our patients undergoing chronic peritoneal dialysis developed fungal peritonitis. Of six treated without removing the catheter two survived after intraperitoneal (IP) administration of imidazole derivatives, and four died despite combined IP and intravenous (IV) therapy. Of four patients treated by catheter removal, all survived, two without any additional therapy and two after IV antifungal treatment. Three of the deaths followed cardiac or cerebral accidents, while one was related to Candida sepsis. Bacterial peritonitis is a frequent complication of peritoneal dialysis (FD). In addition fungal peritonitis has been reported with increasing frequency with the growing diffusion of FD, the subsequent increase in infectious episodes, the antibiotic treatment, which such complications require and the improvement in technique for mycological diagnosis. This paper describes our experience with the clinical manifestations of fungal peritonitis and its treatment in 10 patients undergoing intennittent peritoneal dialysis (IFD) or continuous ambulatory peritoneal dialysis (CAFD).

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Diverticular Disease and Treatment with Gastric Acid Inhibitors do not Predispose to Peritonitis of Enteric Origin in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080102100405 ◽

2001 ◽

Vol 21 (4) ◽

pp. 360-364 ◽

Cited By ~ 9

Author(s):

Gloria Del Peso ◽

María Auxiliadora Bajo ◽

Liliana Gadola ◽

Isabel Millán ◽

Rosa Codoceo ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Gastric Acid ◽

Diverticular Disease ◽

Barium Enema ◽

Tertiary Care ◽

University Hospital ◽

Catheter Removal ◽

Phosphate Binding ◽

Peritoneal Catheter

Objective Enteric peritonitis (EP) is an infrequent complication of peritoneal dialysis (PD), with severe consequences for peritoneal membrane viability and patient outcome. Factors such as diverticular disease and gastric acid inhibitors have been implicated in its appearance. We investigated several risk factors, including those mentioned below, that can influence the development of EP. Design Retrospective cross-sectional study. Setting Tertiary-care public university hospital. Patients Fifty-seven PD patients treated in our PD unit during August 1998. Main Outcome Measures A barium enema was performed on 50 of the 57 patients (the remaining 7 patients refused it) in order to exclude the presence of diverticulosis. All episodes of peritonitis occurring in those patients, including EP, were registered. Enteric peritonitis was defined as that caused by gram-positive, gram-negative, or fungus micro-organisms that colonized the intestinal tract, excluding episodes secondary to genitourinary tract or peritoneal catheter exit-site infections. Results Twenty-four patients showed diverticular disease in the barium enema, but only 5 of them (21%) had any EP episode. Five of the 26 patients with no diverticula (19%) had EP. Fifty-five episodes of peritonitis were reported in 21 patients; 15 episodes of EP (27.3% of all) developed in 11 patients. Seven of the 11 patients (64%) required peritoneal catheter removal and 3 of them (27%) finally were transferred to hemodialysis due to consequences of the EP episode. Logistic regression analysis did not find any of the independent variables analyzed (age, sex, time on PD, type of PD, peritoneal transport parameters, presence of polycystic kidney disease, constipation or diverticulosis, or treatment with gastric acid inhibitors, or phosphate-binding agents) to be risk factors for developing EP. Conclusions Neither diverticulosis nor treatment with gastric acid inhibitors seem to be risk factors for developing peritonitis of enteric origin in PD patients. This type of peritonitis has to be promptly identified and treated in order to diminish the high frequency of peritoneal catheter removal and PD dropout due to such episodes.

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Risk Factors for Poor Outcome of Fungal Peritonitis in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080302302s25 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 123-126 ◽

Cited By ~ 1

Author(s):

Stanley H.K. Lo ◽

Ching-kit Chan ◽

Hoi-ping Shum ◽

Vincent C.C. Chow ◽

Ka-leung Mo ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Chinese Patients ◽

Fungal Peritonitis ◽

Bacterial Peritonitis ◽

Poor Outcome ◽

Risk Of Mortality ◽

Increased Risk ◽

Peritoneal Dialysis Fluid

Objective Fungal peritonitis is rare among end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), but when it occurs, it is associated with a high risk of mortality and peritoneal membrane failure. In the present study, we identified risk factors for poor outcome and examined the effect of treatment profile on outcome in fungal peritonitis. Patients and Methods We identified cases of fungal peritonitis in CAPD patients in a regional dialysis center and analyzed the possible risk factors for poor outcome in fungal peritonitis. To estimate the amount of dextrose presented to the peritoneum, we scored the dextrose content of the peritoneal dialysis fluid used by the patient at the time of admission to hospital (1 point to each bag of 1.5% fluid, 2 points to each bag of 2.3% or 2.5% fluid, and 3 points to each bag of 4.25% fluid daily). Results Among 471 episodes of CAPD-related peritonitis in 7.8 years, we identified 22 episodes of fungal peritonitis (4.7%). The ratio of men to women in the fungal peritonitis group was 1.4:1. Seventeen patients (77.3%) practiced dialysis without a helper. Within the 3 months preceding the fungal peritonitis, 12 patients (55%) had had bacterial peritonitis. Among the cases of fungal peritonitis, we identified 9 cases of Candida parapsilosis and 13 cases of non C. parapsilosis. All of the patients received fluconazole, and 7 patients (31.8%) also received flucytosine. The Tenckhoff catheter was removed in 17 patients (77.3%). Eight patients (36.4%) either died or lost peritoneal function. The risk of mortality was increased if the fungal organism was C. parapsilosis [odds ratio (OR): 4.25; 95% confidence interval (CI): 1.8 to 10.0; p = 0.002], if a helper was involved (OR: 11.3; 95% CI: 1.1 to 114; p = 0.024), or if CAPD duration was more than 26 months (OR: 2.2; 95% CI: 1.3 to 3.5; p = 0.034). Addition of flucytosine to fluconazole did not significantly improve the mortality rate in either the C. parapsilosis or non C. parapsilosis group. Multivariate analysis showed that C. parapsilosis was an independent factor associated with mortality ( p = 0.013). A dextrose score greater than 5 was associated with a trend toward increased risk of peritoneal failure (OR: 3.4; 95% CI: 1.6 to 7.1; p = 0.021). Conclusion C. parapsilosis is an independent risk factor for mortality in fungal peritonitis.

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

Indian Journal of Medical Microbiology ◽

10.1016/s0255-0857(21)01757-6 ◽

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

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NPHS2 gene mutation, atopy, and gender as risk factors for steroid-resistant nephrotic syndrome in Indonesians

Paediatrica Indonesiana ◽

10.14238/pi51.5.2011.272-6 ◽

2011 ◽

Vol 51 (5) ◽

pp. 272 ◽

Cited By ~ 1

Author(s):

Dedi Rachmadi ◽

Danny Hilmanto ◽

Ponpon Ijradinata ◽

Abdurahman Sukadi

Keyword(s):

Risk Factors ◽

Nephrotic Syndrome ◽

Gene Mutation ◽

Significant Risk ◽

Gene Mutations ◽

Male Gender ◽

Amplification Refractory Mutation System ◽

Steroid Resistant ◽

Steroid Resistant Nephrotic Syndrome ◽

Nphs2 Gene

Background Steroid-resistant nephrotic syndrome (SRNS) often develops into end stage renal disease. Previous studies have reported that NPHS2 gene mutation, gender, and atopic history are risk factors associated with SRNS. Interethnic, sociocultural, and environmental differences have also been suggested to affect these mutations.Objective To analyze possible risk factors for SRNS, including NPHS2 gene mutations (412C→T and 419delG), gender and atopic history, in Indonesian subjects with SRNS.Methods A case-control study with 153 subjects, consisting of 88 SRNS patients and 65 control subjects, was undertaken in 10 Indonesian teaching centre hospitals from September 2006 to December 2007. Analysis of the NPHS2 gene mutation in 412 C→T was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR), while that for the NPHS2 gene mutation in 419delG was performed by restriction fragment length polymorphism (RFLP). Data was analyzed by multiple logistic regression.Results In our Indonesian subjects, the significant risk factors for SRNS were male gender (OR=2.21; CI 95%:1.07-4.56, P=0.036), NPHS2 412C→T gene mutation (OR=18.07; CI 95%:6.76-48.31, P<0.001), and NPHS2 419delG gene mutation (OR=4.55; CI 95%:1.66-12.47, P=0.003). However, atopic history was not a significant risk factor for SRNS (OR=1.807; CI 95%:0.642-5.086, P=0.262).Conclusion NPHS2 412C→T and 419delG gene mutations, as well as male gender are risk factors for SRNS in Indonesian subjects. Atopic history was not significantly associated with SRNS in our subjects. [Paediatr Indones. 2011;51:272-6].

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

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00184 ◽

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.

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Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.163123 ◽

2015 ◽

Vol 7 (02) ◽

pp. 108-111 ◽

Cited By ~ 1

Author(s):

Tuhina Banerjee ◽

Shampa Anupurba ◽

Joel Filgona ◽

Dinesh K Singh

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Hospitalized Patients ◽

University Hospital ◽

North India ◽

Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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