Chemotherapy and/or Removal of the Peritoneal Catheter in the Management of Fungal Peritonitis Complicating CAPD?

Cecchin, E; S, De Marchi; Panarello, G.; Tesio, Franco

doi:10.1159/000183473

Cited by 16 publications

(4 citation statements)

References 6 publications

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“…In some reports, cures have been achieved in about 25% of such patients without catheter removal (5,95). There are reports of successful treatment of FP without catheter removal, but most patients treated this way will ultimately require catheter removal (98-101). In a review of the literature on FP in 1992, Nagappan et al (4) summarized the outcome of all FP series published at that time and found that catheter removal alone in 53 episodes of FP resulted in a mortality of 19%, with only 19% of patients able to resume PD.…”

Section: Treatment Of Fpmentioning

confidence: 99%

“…There are, of course, some papers that report successful treatment of FP without catheter removal (6,98-103), but most large studies have shown cure rates of only 10% with antifungal agents without catheter removal (6,101,102). We therefore conclude that the catheter should be removed promptly once FP is diagnosed and attempts at treatment with antifungals alone should not be made, given the high mortality associated with this strategy.…”

Section: Treatment Of Fpmentioning

confidence: 99%

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Fungal Peritonitis in Peritoneal Dialysis Patients

2005

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Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% – 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often “nonpathogenic,” fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques ( e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 – 6 weeks.

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Section: Treatment Of Fpmentioning

confidence: 99%

Section: Treatment Of Fpmentioning

confidence: 99%

Fungal Peritonitis in Peritoneal Dialysis Patients

2005

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“…There are no generally accepted therapeutic regimens for the treatment of FP in patients on CAPD. Management strategies have included early peritoneal catheter removal with or without antifungal therapy, or antifungal therapy with subsequent catheter removal if symptoms persisted (3,5-11). Most investigators agree that catheter removal is an important part of the treatment for FP because the peritoneal catheter provides a site conductive to microbial colonization.…”

Section: Discussionmentioning

confidence: 99%

The Rate, Risk Factors, and Outcome of Fungal Peritonitis in CAPD Patients: Experience in Turkey

2000

Perit Dial Int

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“…With further development in methods for connection of dialysate bags and with greater staff experience, the incidence of peritonitis has now decreased to less than 1.3 episodes per patient-year (24,30). Most series report that about 7% of CAPD-related peritonitis episodes have a fungal etiology (3,5,6,17,24,26,28).…”

mentioning

confidence: 99%