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Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: six years'
K Záruba1, J Peters, H Jungbluth
1Renal Center, City Hospital Waid Zurich, Switzerland.
Abstract:
Fungal peritonitis as a serious complication of continuous ambulatory peritoneal dialysis (CAPD) is often associated with severe morbidity, CAPD "drop-out" and, occasionally, death. Most episodes of fungal peritonitis occur during or after a period of antibiotic treatment of various bacterial infections, usually bacterial peritonitis. From April 1979 to December 1982 (period I), 10 episodes of fungal peritonitis occurred during 415 patient-months, ie, 10.5% of all peritonitis episodes recorded in our CAPD program. After the introduction of oral prophylaxis with 3 x 500,000 IU [corrected] nystatin during every course of antibiotic treatment, only four episodes of fungal peritonitis occurred during 2,102 patient-months, ie, 3.1% of all peritonitis episodes from January 1983 to March 1989 (period II). This difference between the first and second periods is significant (P less than 0.05). Moreover, none of the four patients who contracted fungal peritonitis in the second period received nystatin prophylaxis. Thus, the simple measure of oral prophylaxis using this nonabsorbable antifungal agent in every case of an antibiotic treatment largely eliminates the risk of fungal peritonitis in patients on CAPD.
Insights
Oral nystatin prophylaxis significantly reduces fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. This simple measure, given during antibiotic treatment, largely eliminates the risk of this serious CAPD complication.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Mycology
Background:
- Fungal peritonitis is a severe complication of continuous ambulatory peritoneal dialysis (CAPD).
- It frequently arises following antibiotic therapy for bacterial infections, particularly bacterial peritonitis.
- This complication leads to significant morbidity, treatment cessation (CAPD drop-out), and mortality.
Purpose of the Study:
- To evaluate the efficacy of oral nystatin prophylaxis in preventing fungal peritonitis in CAPD patients.
- To assess the impact of nystatin prophylaxis on the incidence of fungal peritonitis during antibiotic treatment.
Main Methods:
- A retrospective study comparing two periods: before (Period I) and after (Period II) implementing oral nystatin prophylaxis.
- Period I: April 1979–December 1982 (no prophylaxis).
- Period II: January 1983–March 1989 (oral nystatin 3x500,000 IU during all antibiotic courses).
Main Results:
- In Period I, 10 fungal peritonitis episodes occurred (10.5% of all peritonitis) over 415 patient-months.
- In Period II, the incidence decreased to 4 episodes (3.1% of all peritonitis) over 2,102 patient-months.
- The reduction in fungal peritonitis incidence was statistically significant (P < 0.05).
Conclusions:
- Oral nystatin prophylaxis is a highly effective strategy for preventing fungal peritonitis in CAPD patients.
- Administering nonabsorbable oral antifungals like nystatin during antibiotic courses significantly mitigates the risk.
- This preventative measure improves outcomes for CAPD patients by reducing a major complication.