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Intracatheter Antifungal Lock Leading to Detrimental Complications

Pongpratch Puapatanakul1, Nuttha Lumlertgul1, Nisa Thongbor2

  • 1Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.

Medical Mycology Case Reports
|October 2, 2018
PubMed

Insights

Fungal peritonitis in peritoneal dialysis (PD) patients can be fatal. Antifungal lock therapy, used in two cases without PD catheter removal, failed to treat the infection and worsened outcomes.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Medical Device Management

Background:

  • Peritoneal dialysis (PD)-related fungal infections carry high mortality.
  • International guidelines mandate PD catheter removal and 2-week antifungal therapy.
  • Antifungal lock therapy in retained PD catheters is an alternative but not widely accepted approach.

Observation:

  • Two cases of PD-related fungal infection were treated with antifungal lock therapy.
  • The PD catheters were retained in both patients.
  • Treatment involved instilling antifungal solutions into the PD catheter.

Findings:

  • Antifungal lock therapy was ineffective in resolving the fungal peritonitis.
  • Paradoxical outcomes, suggesting a worsening of the condition, were observed.
  • This challenges the efficacy of antifungal locks as a standalone treatment.

Implications:

  • The findings question the utility of antifungal lock therapy for PD-related fungal infections.
  • Retained PD catheters in fungal peritonitis may lead to adverse events.
  • Current treatment guidelines emphasizing catheter removal should be reconsidered cautiously.
Keywords:
Fungal peritonitisIntracatheterParadoxicalPeritoneal dialysis (PD)

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