Can Intracatheter Retention of Antifungal Agents Cure Fungal Peritonitis? Two Cases Successfully Treated without Catheter Removal

Tsai, Tun-Jun; Chen, Yung-Mjng; Hsieh, Bor‐Shen; Chen, Wan‐Yu; Yen, Tsan-Shin

doi:10.1177/089686089101100412

Cited by 10 publications

(11 citation statements)

References 4 publications

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“…Two patients who developed FP were successfully treated with intracatheter retention of amphotericin B 1 – 2 mg and oral flucytosine or fluconazole 50 mg twice per day for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained (115,116).…”

Section: Treatment Of Fpmentioning

confidence: 99%

Fungal Peritonitis in Peritoneal Dialysis Patients

2005

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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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Section: Treatment Of Fpmentioning

confidence: 99%

Fungal Peritonitis in Peritoneal Dialysis Patients

2005

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“…The second scenario was a straight-forward situation where a case of definite fungal peritonitis was treated conservatively by systemic and intracatheter antifungal lock therapy without PD catheter removal. This practice was homologous to the successful cases in previous reports [5] , [6] , [17] , [18] . Because the infections had not been present at the beginning of peritonitis, subsequent infections in the second case may have resulted from fungal invasion through the PD catheter.…”

Section: Discussionmentioning

confidence: 65%

“…While emergent PD catheter removal has been suggested to improve patient outcomes in many studies, some authors recommend delayed removal in light of the potential benefits to enable peritoneal lavage using antifungal agents in the first few days. Moreover, there were some reports in which patients with fungal peritonitis were treated successfully by utilizing a combination of systemic antifungal therapy and intracatheter antifungal lock therapy without the need for PD catheter removal [6] , [17] , [18] given the fact that several options for treating fungal peritonitis in PD patients were possible. Although the ISPD guidelines 2016 recommends immediate peritoneal catheter removal if fungi are identified in the PD effluent, the level of evidence is graded as “low”, and the guidelines do not mention about intracatheter antifungal locks nor do they discourage this practice.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the 2016 update of the International Society of PD (ISPD) Guidelines recommends that the PD catheter should be removed immediately (1C) and for appropriate antifungal agents to be administered for at least 2 weeks following PD catheter removal (2C) when fungi are identified in the PD effluent [4] . However, there have been two reports of fungal peritonitis in patients who were successfully treated by intracatheter antifungal retention of amphotericin B 1–1.5 mg combined with systemic antifungal therapy without the need for PD catheter removal [5] , [6] . Moreover, a high salvage rate of central and peripheral lines; including Hickman, central venous, Broviac, and peripheral catheters using anti-fungal lock therapy has been reported with various choices of antifungal regimens such as amphotericin B, anidulafungin, caspofungin, ethanol, fluconazole, and itraconazole [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] .…”

Section: Introductionmentioning

confidence: 99%

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Intracatheter Antifungal Lock Leading to Detrimental Complications

Puapatanakul

Lumlertgul

Thongbor

et al. 2018

Medical Mycology Case Reports

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As peritoneal dialysis (PD)-related fungal infection is associated with a high mortality rate, the international guidelines recommend immediate removal of the PD catheter in conjunction with at least 2-weeks of antifungal treatment. Some authors have reported successful management of such cases without removing the PD catheter - by instilling an antifungal lock into the retained PD catheter. However, the use of antifungal locks has generally not been well accepted as the standard treatment for fungal peritonitis in PD patients. We report two cases where antifungal lock were performed in PD patients presented with PD-related fungal infection that not only had no effect on abating the infection but also causing paradoxical outcomes.

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“…Alternative treatment approaches to defer catheter removal operation should be considered, such as a catheter conservative therapy. There are various regimens of intracatheter retention regimens aiming for catheter preservation in fungal peritonitis, including amphotericin B and alcohol [ 10 , 11 ]; however, all were utilized in the patients without PD catheter obstruction. Lyticase, a combination of lytic enzymes endoglucanase and alkaline protease specific for disruption of fungal cell wall leading to cell lysis, has been used in-situ to treat candida and pseudomonal biofilms with impressive results [ [12] , [13] , [14] , [15] ].…”

Section: Introductionmentioning

confidence: 99%

Promising effect of in-situ lyticase enzyme therapy on peritoneal dialysis catheter obstruction from Acremonium fungal biofilm: A case report

Thongsricome

Kanjanabuch

Maeboonruen

et al. 2020

Medical Mycology Case Reports

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We reported the first clinical use of lyticase enzyme in salvaging the peritoneal dialysis (PD) catheter obstruction from Acremonium fungal biofilm during the COVID-19 pandemic era with an impressive result in PD patient presenting with fungal peritonitis and ultrafiltration failure. The organism species was disclosed from PD effluent and catheter cultures. Adjuvant treatment with in-situ lyticase may be considered for catheter salvage therapy if it is not promptly removed in time.

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Can Intracatheter Retention of Antifungal Agents Cure Fungal Peritonitis? Two Cases Successfully Treated without Catheter Removal

Cited by 10 publications

References 4 publications

Fungal Peritonitis in Peritoneal Dialysis Patients

Fungal Peritonitis in Peritoneal Dialysis Patients

Intracatheter Antifungal Lock Leading to Detrimental Complications

Promising effect of in-situ lyticase enzyme therapy on peritoneal dialysis catheter obstruction from Acremonium fungal biofilm: A case report

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