Serum Galactomannan Index for the Rapid Diagnosis of Fungal Peritonitis in Patients With Peritoneal Dialysis

Chamroensakchai, Tamonwan; Manuprasert, Wasin; Puapatanakul, Pongpratch; Saejew, Thunvarat; Leelahavanichkul, Asada; Chatsuwan, Tanittha; Halue, Guttiga; Lorvinitnun, Pichet; Tangjittrong, Kittisak; Pongpirul, Krit; Tungsanga, Kriang; Eiam‐Ong, Somchai; Johnson, David W.; Towannang, Piyaporn; Thongbor, Nisa; Sritippayawan, Suchai; Aiyasanon, Nipa; Kaewboonsert, Donkum; Uttayotha, Pensri; Sopassathit, Wichai; Pitakmongkol, Salakjit; Poonvivatchaikarn, Ussanee; Jaroenpattrawut, Bunpring; Buranaosot, Somphon; Nilvarangkul, Sukit; Satitkan, Warakoan; Somboonsilp, Wanida; Wongtrakul, Pimpong; Tongpliw, Ampai; Pullboon, Anocha; Boonyakrai, Chanchana; Jankramol, Montha; Narenpitak, Surapong; Wechpradit, Apinya; Tatiyanupanwong, Sajja; Kleebchaiyaphum, Chadarat; Saikong, Wadsamon; Panya, Worauma; Thaweekote, Siriwan; Uppamai, Sriphrae; Phisutrattanaporn, Jarubut; Sirinual, Sirirat; Panyatong, Setthapon; Taruangsri, Puntapong; Prasertkul, Boontita; Buanet, Thanchanok; Chieochanthanakij, Rutchanee; Passorn, Panthira; Lounseng, Niwat; Luksanaprom, Rujira; Wongpiang, Angsuwarin; Chaiwut, Metinee; Treamtrakanpon, Worapot; Phaichan, Ruchdaporn; Rattanasoonton, Peerapach; Thongsiw, Wanlaya; Lukrat, Narumon; Thaitrng, Sayumporn; Songviriyavithaya, Phichit; Laoong, Yupha; Pikul, Niparat; Parinyasiri, Uraiwan; Rukchart, Navarat; Sukmee, Korawee; Chantarungsri, Wandee

doi:10.1016/j.ekir.2019.12.008

Cited by 6 publications

(10 citation statements)

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“…156 For rapid diagnosis of fungal peritonitis, PD effluent and serum galactomannan index might offer a faster turnaround time than the conventional culture method, but with a diagnostic accuracy of 65.2% sensitivity, 85.0% specificity only. 157,158 False-positive galactomannan results 159 leading to unnecessary use of antifungals is a definite concern.…”

Section: Other Novel Diagnostic Techniquesmentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

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Section: Other Novel Diagnostic Techniquesmentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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“…Therefore, the presence of catheter problems was a protective factor on patients’ mortality in our study. Not surprisingly, a positive galactomannan test (a diagnostic marker for invasive fungal infections and PD-related peritonitis [ 24 , 25 ] and a prognostic marker for invasive aspergillosis in critical illness patients [ 26 ]) was detected less frequently in PDE from patients with yeast peritonitis (61%) than those with mold peritonitis (76–81%). Generally, yeasts contain a low amount of galactomannan in their cell walls, and Pneumocystis jiroveci and Candida spp.…”

Section: Resultsmentioning

confidence: 99%

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

Kanjanabuch

Nopsopon²,

Chatsuwan

et al. 2022

PLoS ONE

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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.

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“…The recommended regimens of antifungal agents used in this study were either of the following: (i) voriconazole 200 mg tablet at a dose of 6 mg/kg/dose twice daily on the first day, followed by 4 mg/kg/dose twice daily for 14 days and (ii) amphotericin B at 1 mg/kg/day in combination with 5-fluorocytosine 500 mg tablet twice daily for 14 days. To mitigate the risk of artifactual serum GM results during blood collection and handling, a protocol collection 7 was emphasized to charge nurses as follows: applying the tourniquet during venous puncture for no longer than 1 minute and avoiding fist-clenching, completing air dry after cleaning the puncture area with 70% alcohol (avoiding iodine-containing or chlorhexidine-containing antiseptic agents), using a 20 to 22 gauge needle, placing the bevel of the needle face-up, collecting blood only from the antecubital region of the arm, pulling the syringe plunger gently, drawing the blood into sterile sodium citrate tube and mixing thoroughly by inverting the tube slowly 3 to 4 times, separating the serum by centrifugation at 150 g for 5 minutes, and shipping the separated serum to the local laboratory. Serum samples were stored at −70 °C until analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…For fungal culture, the pellet from another 50 ml of centrifuged PDE was streaked on Sabouraud dextrose agar, blood agar (Oxoid), and specific agar plates (as needed) then incubated at 25 °C and 37 °C for 15 to 30 days. Bacterial pathogens were identified by Gram stain and Vitek MS system (bioMérieux, USA), 7 whereas fungi were identified by API20c AUX kit (bioMérieux, Marcy l’Etoile, France) based on biochemical reactions and stained by Lactophenol Cotton Blue technique to classify mold-form fungi based on the morphology of their sexual spores and conidia. To exclude coincidental infection with Mycobacterium organisms, the pellet from an additional 50 ml PDE was inoculated in Ogawa medium slants and BACTEC MGIT 960 media for 2 months.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Serum Galactomannan Index for the Rapid Diagnosis of Fungal Peritonitis in Patients With Peritoneal Dialysis

Cited by 6 publications

References 9 publications

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

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

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

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