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Antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients
N K Wadhwa1, H Suh, T Cabralda
1Department of Medicine, State University of New York at Stony Brook, USA.
Abstract:
Our objective was to evaluate antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients. The study was designed to investigate antifungal prophylaxis for fungal peritonitis and to compare the incidence of fungal peritonitis without (January, 1991-July, 1993) and with (August, 1993-December, 1995) antifungal prophylaxis. In a tertiary-referral university hospital, 122 end-stage renal disease (ESRD) patients (77 male, 45 female) during period A (1/91-7/93) were observed for 1832 patient-months with no antifungal prophylaxis. One hundred and twelve ESRD patients (71 male, 41 female) during period B (8/93-12/95) were observed over 1705 patient-months with antifungal prophylaxis with fluconazole. Fluconazole 200 mg was given orally (po) as first dose at the onset of antibiotic therapy, then 100 mg po every other day, and was continued for one week after the antibiotic therapy. Forty-nine patients (28 male, 21 female; mean age 48.8 years) developed 105 episodes of peritonitis during period A. Forty-eight patients (36 male, 12 female; mean age 53.8 years) developed 95 episodes of peritonitis during period B. Fifteen episodes of fungal peritonitis occurred over 1832 patient-months during period A. while four episodes of fungal peritonitis were observed over 1705 patient-months during period B. Twelve episodes of secondary fungal peritonitis occurred during period A, while only two episodes occurred during period B. This incidence of secondary fungal peritonitis was significantly reduced with antifungal prophylaxis (p < 0.02). No side effect of fluconazole was observed. In conclusion, secondary fungal peritonitis was significantly decreased following fluconazole antifungal prophylaxis at our center.
Insights
Antifungal prophylaxis with fluconazole significantly reduced secondary fungal peritonitis in peritoneal dialysis patients. This preventative measure proved safe and effective, decreasing infection rates in end-stage renal disease patients undergoing dialysis.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Secondary fungal peritonitis is a serious complication in patients undergoing peritoneal dialysis.
- Effective prophylaxis strategies are crucial for managing infection risk in end-stage renal disease (ESRD) patients.
- Previous incidence rates of fungal peritonitis in ESRD patients on peritoneal dialysis were high.
Purpose of the Study:
- To evaluate the efficacy of antifungal prophylaxis in preventing secondary fungal peritonitis.
- To compare the incidence of fungal peritonitis before and after implementing antifungal prophylaxis.
Main Methods:
- A retrospective study comparing two periods: January 1991-July 1993 (no prophylaxis) and August 1993-December 1995 (with fluconazole prophylaxis).
- 122 ESRD patients observed for 1832 patient-months without prophylaxis; 112 ESRD patients observed for 1705 patient-months with fluconazole prophylaxis.
- Fluconazole prophylaxis regimen: 200 mg oral loading dose, then 100 mg oral every other day, continued for one week post-antibiotic therapy.
Main Results:
- Fifteen episodes of fungal peritonitis occurred during the non-prophylaxis period (1832 patient-months).
- Four episodes of fungal peritonitis occurred during the prophylaxis period (1705 patient-months).
- Secondary fungal peritonitis incidence decreased significantly from 12 episodes to 2 episodes with fluconazole prophylaxis (p < 0.02).
Conclusions:
- Fluconazole antifungal prophylaxis significantly reduced the incidence of secondary fungal peritonitis in peritoneal dialysis patients.
- The implemented prophylaxis regimen was well-tolerated with no observed side effects.
- Antifungal prophylaxis is an effective strategy for preventing fungal peritonitis in this patient population.