Fungal peritonitis in peritoneal dialysis patients: successful prophylaxis with fluconazole, as demonstrated by prospective randomized control trial
- PMID: 20634438
- DOI: 10.3747/pdi.2008.00189
Fungal peritonitis in peritoneal dialysis patients: successful prophylaxis with fluconazole, as demonstrated by prospective randomized control trial
Erratum in
- Perit Dial Int. 2011 Mar-Apr;31(2):120
Abstract
Objectives: To 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 methods: All 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. ♢
Results: The 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. ♢
Conclusion: In patients with bacterial peritonitis, administration of prophylactic oral fluconazole throughout the time they received antibiotics significantly prevented the appearance of secondary fungal peritonitis.
Similar articles
-
Long-term peritoneal dialysis experience: quality control supports the use of fluconazole to prevent fungal peritonitis.Int J Artif Organs. 2013 Jul;36(7):484-8. doi: 10.5301/ijao.5000219. Epub 2013 May 10. Int J Artif Organs. 2013. PMID: 23661559
-
Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.Cochrane Database Syst Rev. 2017 Apr 8;4(4):CD004679. doi: 10.1002/14651858.CD004679.pub3. Cochrane Database Syst Rev. 2017. PMID: 28390069 Free PMC article. Review.
-
Unsuccessful application of taurolidine in the treatment of fungal peritonitis in peritoneal dialysis.Clin Nephrol. 2011 Jan;75(1):70-3. Clin Nephrol. 2011. PMID: 21176753
-
Long-Term Exit-Site Gentamicin Prophylaxis and Gentamicin Resistance in a Peritoneal Dialysis Program.Perit Dial Int. 2016 Jul-Aug;36(4):387-9. doi: 10.3747/pdi.2015.00162. Epub 2015 Dec 3. Perit Dial Int. 2016. PMID: 26634567 Free PMC article.
-
Fungal peritonitis in patients on peritoneal dialysis.Am J Nephrol. 1994;14(2):113-20. doi: 10.1159/000168699. Am J Nephrol. 1994. PMID: 8080003 Review.
Cited by
-
Delayed Diagnosis and Treatment of Rare Fungal Peritoneal Dialysis-Associated Peritonitis.Cureus. 2024 Aug 13;16(8):e66796. doi: 10.7759/cureus.66796. eCollection 2024 Aug. Cureus. 2024. PMID: 39268265 Free PMC article.
-
Fungal Peritonitis Secondary to Aspergillosis in a Peritoneal Dialysis Patient.J Community Hosp Intern Med Perspect. 2022 Nov 7;12(6):113-115. doi: 10.55729/2000-9666.1115. eCollection 2022. J Community Hosp Intern Med Perspect. 2022. PMID: 36816167 Free PMC article.
-
Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study.Front Med (Lausanne). 2021 Dec 1;8:774946. doi: 10.3389/fmed.2021.774946. eCollection 2021. Front Med (Lausanne). 2021. PMID: 34926517 Free PMC article.
-
Continuous Ambulatory Peritoneal Dialysis Peritonitis Guidelines - Consensus Statement of Peritoneal Dialysis Society of India - 2020.Indian J Nephrol. 2021 Sep-Oct;31(5):425-434. doi: 10.4103/ijn.IJN_73_19. Epub 2021 Sep 21. Indian J Nephrol. 2021. PMID: 34880551 Free PMC article. Review.
-
The Emerging Uncommon Non-Albicans Candida: Candida Parapsilosis Peritonitis in a Peritoneal Dialysis Patient.Cureus. 2021 Aug 11;13(8):e17083. doi: 10.7759/cureus.17083. eCollection 2021 Aug. Cureus. 2021. PMID: 34527470 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical