FUNGAL EXIT SITE INFECTIONS (ESI) AND FUNGAL PERITONITIS (FP) OVER A 20 YEAR PERIOD WITH AND WITHOUT EXIT SITE PROPHYLAXIS

Laura Ferreira Provenzano, Heena Sheth, Filitsa Bender, Beth PirainoRenal and Electrolytes Division, University of Pittsburgh Medical Center , PA, USA

To study the effects of ESI prophylaxis on fungal infection rates we divided the 20-year period into 3 sub-periods:

1)No prophylaxis2)Mupirocin at the ES 3) Predominantly gentamicin at the ES

This was a retrospective analysis of prospectively collected data from an IRB approved registry with all patients (pts) giving consent. Incident cases within each period were included.

Background

Objectives/Purpose

Methods

Summary and Conclusions

Results

Antibiotics use at the exit site (ES) as routine care reduces the risk of bacterial ESI and peritonitis.

However, there is concern this might increase the risk of fungal infections.

To study fungal infection rates in a single PD program over a 20-year period and their association with ESI prophylaxis.

Study period

1980-1992

1992-2001

2001-2010

P value

Incident cases

341 183 150 ---

Median age (y)

45.7* 50.9* 52.7 *0.01

Female (%) 181(53) 99(54.1) 77(51.3) ns

AA (%) 42(12.3) 29(15.8) 41(27.5) <0.0001

PD time (mo)

14.1 13.3 15.9 0.024

Table 1. Demographics are shown below:

Table 2. Infectious data as % and as rates is shown below:

Study period 1980-1992 1992-2001 2001-2010

Years at risk 552 181 198

Bacterial ESI (epis/y) 0.861,2 0.581,3 0.262,3

Bacterial P (epis/y) 0.774,5 0.524,6 0.285,6

Fungal ESI (% of pts)

2 (0.58) 0 (0) 3 (2)

Fungal P (% of pts) 4 (1.2) 4 (2.19) 4 (2.7)

Fungal ESI (epis/y) 0.00367 08 0.0157,8

Fungal P (epis/y) 0.0079,10 0.0229 0.0210

1 p=0.0001; 2 p<0.0001; 3 p<0.0001; 4 p<0.0001; 5 p<0.0001; 6 p=0.0003; 7 p=0.069; 8 p=0.07; 9 p=0.07; 10 p=0.08

In summary, fungal infections in our program are extremely uncommon.

The use of a broader spectrum ATB (gentamicin) for routine ES care was associated with a striking reduction in bacterial peritonitis and an insignificant increase in fungal infections.

We recommend the use of gentamicin at the exit site for all PD patients.

Study period

1980-1992

1992-2001

2001-010

P value

Incident cases

341 183 150 ---

Median age (y)

45.7* 50.9* 52.7 *0.01

Female (%)

181(53) 99(54.1) 77(51.3) ns

AA (%) 42(12.3) 29(15.8) 41(27.5) <0.0001

PD time (mo)

14.1 13.3 15.9 0.024

Study period 1980-1992 1992-2001 2001-2010Years at risk 552 181 198Bacterial ESI (epis/y) 0.861,2 0.581,3 0.262,3

Bacterial P (epis/y) 0.774,5 0.524,6 0.285,6

Fungal ESI (% of pts) 2 (0.58) 0 (0) 3 (2)Fungal P (% of pts) 4 (1.2) 4 (2.19) 4 (2.7)Fungal ESI (epis/y) 0.00367 08 0.0157,8

Fungal P (epis/y) 0.0079,10 0.0229 0.0210

Impact of pre-printed order forms

020406080

100

Positive Neutral/Negative

% responses