title: Long-term peritoneal dialysis experience: quality control supports the use of fluconazole to prevent fungal peritonitis.
abstract: BACKGROUND
  Fungal peritonitis (FP) is rare, but it is associated with high morbidity and mortality.
  
  
  METHODS
  A prospective study was conducted based on the peritonitis episodes registry to evaluate FP rate, possible risk factors, and outcomes. The impact of prophylactic intervention with oral fluconazole was evaluated.
  
  
  RESULTS
  Over 24 years of experience, 417 patients underwent peritoneal dialysis (PD), followed for 956 patient-years. By the end of the study, the peritonitis rate reached 0.47 episodes per patient-year of treatment (ep/pt-y). FP was detected in 24 patients. The global rate of FP was 0.03 ep/pt-y (4.8%). Candida species accounted for 92% of the FP. Risk factors identified: recent use of antibiotics in 63% (13 episodes of bacterial peritonitis and 2 exit-site infections (ESI)) and immunosuppressive therapy in 8%. While rare, the FP proportion was still observed to increase from the beginning of the program, reaching 7.8% (0.05 ep/pt-y). A strategy of antifungal prophylaxis with oral fluconazole during peritonitis or ESI antibiotic therapy was adopted, which allowed thereafter a 4.0% falling FP proportion (by study end, rate of 0.01 ep/pt-y). Catheter removal occurred in all patients. The mortality rate was 12.5%. Reinsertion of dialysis catheter was attempted in 4 patients and PD was successfully resumed in 3 patients.
  
  
  CONCLUSIONS
  FP was associated with high mortality and required early removal of the catheter in all patients. Recent use of antibiotics was a predisposing factor to PF. The quality control process determined a prophylactic strategy and reduction of PF after introduction of oral fluconazole was implemented.
authors: Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Quinta dos Vales, Coimbra, Portugal. karinalopes17@gmail.com
authors: Karina
authors: K
authors: Lopes
authors: Ana
authors: A
authors: Rocha
authors: Anabela
authors: A
authors: Rodrigues
authors: Maria João
authors: MJ
authors: Carvalho
authors: António
authors: A
authors: Cabrita
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D004334:Drug Administration Schedule; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000592:standards*; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011786:Quality Control; D011787:Quality of Health Care / Q000592:standards*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole