Predictors and outcomes of peritoneal dialysis-related infections due to filamentous molds (MycoPDICS)

Abstract

Introduction We sought to evaluate the predictors and outcomes of mold peritonitis in patients with peritoneal dialysis (PD). Methods This cohort study included PD patients from the MycoPDICS database who had fungal peritonitis between July 2015-June 2020. Patient outcomes were analyzed by Kaplan Meier curves and the Log-rank test. Multivariable Cox proportional hazards model regression was used to estimating associations between fungal types and patients’ outcomes. Results The study included 304 fungal peritonitis episodes (yeasts n = 129, hyaline molds n = 122, non-hyaline molds n = 44, and mixed fungi n = 9) in 303 patients. Fungal infections were common during the wet season (p <0.001). Mold peritonitis was significantly more frequent in patients with higher hemoglobin levels, presentations with catheter problems, and positive galactomannan (a fungal cell wall component) tests. Patient survival rates were lowest for non-hyaline mold peritonitis. A higher hazard of death was significantly associated with leaving the catheter in-situ (adjusted hazard ratio [HR] = 6.15, 95%confidence interval [CI]: 2.86–13.23) or delaying catheter removal after the diagnosis of fungal peritonitis (HR = 1.56, 95%CI: 1.00–2.44), as well as not receiving antifungal treatment (HR = 2.23, 95%CI: 1.25–4.01) or receiving it for less than 2 weeks (HR = 2.13, 95%CI: 1.33–3.43). Each additional day of antifungal therapy beyond the minimum 14-day duration was associated with a 2% lower risk of death (HR = 0.98, 95%CI: 0.95–0.999). Conclusion Non-hyaline-mold peritonitis had worse survival. Longer duration and higher daily dosage of antifungal treatment were associated with better survival. Deviations from the 2016 ISPD Peritonitis Guideline recommendations concerning treatment duration and catheter removal timing were independently associated with higher mortality.

Serum Galactomannan: A Predictor of Poor Outcomes in Peritoneal Dialysis Patients With Fungal Peritonitis

“…In other words, fungal peritonitis actually has the worst outcomes of all peritonitis. 11 The mortality rate ranges from 9% to 60%, 1 , 3 , 12 , 13 , 14 , 15 and is 2 to 3 folds higher among those who do not undergo catheter removal. 4 Our study demonstrates a consistent mortality rate of 15%.…”

“…The MycoPDICS database is a national registry designed to survey the incidence of PD-related infections with fungus or environmental organisms under the Nephrology Society of Thailand, which has been launched since 2015 and aims to monitor incidence, disease trends and risk factors of fungal and environmental infections in patients on PD. 1 All reporting was performed under the Strengthening the Reporting Diagnostic Accuracy Studies guidelines ( Supplementary Figure S1 ).…”

“…Fungal peritonitis constitutes 1% to 23% of peritonitis cases. 1 It leads to serious complications of PD, high rates of transfer to hemodialysis (40%–55%) and mortality (5%–53%). 1 , 2 PD Catheter removal within 24 hours after the diagnosis of fungal peritonitis markedly reduces the mortality rate compared to those with delayed catheter removal (13% vs. 32%, respectively).…”

“… 1 It leads to serious complications of PD, high rates of transfer to hemodialysis (40%–55%) and mortality (5%–53%). 1 , 2 PD Catheter removal within 24 hours after the diagnosis of fungal peritonitis markedly reduces the mortality rate compared to those with delayed catheter removal (13% vs. 32%, respectively). 3 Therefore, the 2022 International Society for Peritoneal Dialysis Peritonitis Guidelines recommend immediate catheter removal when the diagnosis of fungal peritonitis is made.…”

A successful management of fungal peritonitis caused by Rhodotorula glutinis in CAPD patient, coincident with onychomycosis by Penicillium sp: Case report

“…[6] There is a wide spectrum of fungi as causative organisms of fungal peritonitis, that is yeast, hyaline mold, and non-hyaline mold, with approximately 80 fungal species being potential causative organisms. [11] Candida belongs to the yeast family and is the predominant cause (65.1%-100%) of fungal peritonitis. [2][3][4]6,12] Our case demonstrated a R glutinis-related PD peritonitis that was successfully managed with voriconazole and catheter removal.…”