Catheter Removal for Fungal Peritonitis: Sooner or Later?

Wc, Lye

doi:10.1177/089686080802800206

Cited by 4 publications

(2 citation statements)

References 25 publications

(25 reference statements)

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“…In our centre, FP was confirmed as an important cause of definitive PD drop out (100%), burdened by a considerable risk of morbidity and mortality (14%). The worldwide mortality rate is variable, ranging between 5 and 40% [ 3–15 ], being at the highest level in patients with loss of residual kidney function [ 45 ] and in those whose peritoneal catheter was not removed quickly once diagnosed [ 1 , 2 ]. In our cohort, patients who died because of FP had a higher burden of comorbidity, less residual urine output (on average 800 mL/day) [ 46 ] and a longer hospitalization time (50–60 day).…”

Section: Discussionmentioning

confidence: 99%

Fungal peritonitis in peritoneal dialysis: a 34-year single centre evaluation

Auricchio

Giovenzana

Pozzi

et al. 2018

Clinical Kidney Journal

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BackgoundFungal peritonitis (FP) is one of the most important causes of peritoneal dialysis (PD) failure, often burdened by increased morbility and mortality. This study evaluates the clinical course of FP cases that arose between 1983 and 2016 in a single PD unit.MethodsWe conducted a retrospective observational analysis of FP episodes recorded in the Baxter POET (Peritonitis Organism Exit sites Tunnel infections) registry and clinical records. FP incidence rate, PD and patients’ survival and clinical characteristics of the study population were analysed, taking into account the evolution of clinical practice during the study period as a result of technical innovation, scientific evidence and guideline history.ResultsFourteen FP cases (2.8%) were detected. The overall incidence of PD peritonitis was one episode/27 patient-months. Candida parapsilosis was the most frequently (50%) detected yeast. Seventy-five per cent of cases were considered secondary FP. This group experienced 2.6±1.7 bacterial peritonitis before FP, most frequently due to Staphylococcus and Enterococcus species. Most patients were treated with fluconazole for ≥8 days. All subjects were hospitalized for a median time of 25 days. Tenckhoff catheter removal occurred in all cases of FP and all patients were transferred to haemodialysis. Two patients died. From December 2010 to December 2016, no FP episodes were recorded.ConclusionsFP is confirmed as a significant cause of PD drop out and increases patients’ mortality risk. Prompt diagnosis of FP, targeted antifugal therapy and rapid PD catheter removal are essential strategies for improved patient and PD survival.

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Section: Discussionmentioning

confidence: 99%

Fungal peritonitis in peritoneal dialysis: a 34-year single centre evaluation

Auricchio

Giovenzana

Pozzi

et al. 2018

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

“…The practice of rapid removing the peritoneal catheter accompanied by oral antifungal therapy on confirming the diagnosis is very common in some centers, including ours (24)(25)(26), although the use of intracatheter or intravenous amphotericin B, combined with oral flucytosine and intraperitoneal fluconazole in short intervals, has saved a few patients and catheters (27). Other groups recommend treatment of fungal peritonitis and simultaneous catheter removal (28), or delaying catheter removal until the dialysate effluent has cleared (29), the current suggestion being that this scheme is recommended only for elderly or frail patients with little capacity to support a move to hemodialysis (30,31). It has been suggested that antibiotic therapy destroys the normal bacterial flora of the colon, can be a risk factor for development of fungal peritonitis, and promotes colonization and overgrowth of yeast in the digestive tract, with future migration into the peritoneal cavity by routes not well defined so far.…”

Section: Discussionmentioning

confidence: 99%