title: Unsuccessful application of taurolidine in the treatment of fungal peritonitis in peritoneal dialysis.
abstract: Fungal peritonitis (FP) is a serious complication for peritoneal dialysis (PD) patients, determining hospitalization, technique failure, catheter loss and death. In the 2005 update, treatment recommendations for FP from the International Society of Peritoneal Dialysis (ISPD) advocate catheter removal immediately after fungi are identified by microscopy or culture. The availability of more effective medical treatments could therefore be of great importance. The aim of this report is to describe a case of a 43-year-old, diabetic, HIV positive PD patient with fluconazole resistant Candida peritonitis, who was treated with an i.p. taurolidine solution. Taurolidine is a non-antibiotic antimicrobial, with broad bactericidal and fungicidal properties. It has been used during surgery for lavage of the peritoneum in cases of peritonitis. Its mechanism of action is related to direct toxic action on micro-organisms, through a chemical reaction between active taurolidine derivatives and structures on the cell wall. Treatment failed because the patient had severe burning pain during i.p. administration of the drug, limiting its dose. PD catheter removal allowed complete recovery. It remains undetermined if, with different doses and methodology, taurolidine could be more effective in treating bacterial and/or fungal peritonitis. Currently, catheter removal remains the most effective therapy of fungal peritonitis.
authors.affiliation: Dipartimento Medicina Chirurgia Odontoiatria, Università degli Studi di Milano, Italy. maurizio.gallieni@unimi.it
authors.forename: M
authors.initials: M
authors.lastname: Gallieni
authors.forename: G
authors.initials: G
authors.lastname: Chiarelli
authors.forename: L
authors.initials: L
authors.lastname: Olivi
authors.forename: M
authors.initials: M
authors.lastname: Cozzolino
authors.forename: D
authors.initials: D
authors.lastname: Cusi
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010146:Pain / Q000209:etiology; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D013654:Taurine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013829:Thiadiazines / Q000008:administration & dosage* / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D000935:Antifungal Agents; D013829:Thiadiazines; D013654:Taurine; C012566:taurolidine; D015725:Fluconazole