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Retrospective Analysis on the Efficacy and Adverse Effects of Antifungal Prophylaxis in Patients with Peritoneal Dialysis-Associated Peritonitis

Summary

This study examined whether giving antifungal medications to peritoneal dialysis patients with infections could prevent fungal peritonitis. The researchers found that patients receiving antifungal prophylaxis actually had higher rates of secondary fungal infections compared to those without it. Additionally, fluconazole treatment was associated with dangerous changes in heart electrical activity, suggesting potential cardiac risks.

Background

Fungal peritonitis causes significant mortality in patients on peritoneal dialysis (PD), with antibiotic exposure being a major risk factor. The 2016 and 2022 ISPD Guidelines recommend antifungal prophylaxis in PD patients on antibiotics, though optimal prevention strategies remain unclear.

Objective

To evaluate the impact of antifungal prophylaxis on patients with PD-associated peritonitis as secondary prevention for fungal peritonitis and assess associated adverse effects such as QTc prolongation.

Results

Of 101 PD-associated peritonitis patients, 33 (32.7%) received antifungal prophylaxis and 68 (67.3%) did not. Secondary fungal peritonitis developed in 6.1% of prophylaxis-treated patients versus 1.5% without prophylaxis. Among fluconazole-treated patients with repeat ECGs, 70% had QTc >460 ms and 30% had QTc >500 ms.

Conclusion

Antifungal prophylaxis in PD-associated peritonitis does not correlate with fewer episodes of secondary fungal peritonitis. Increased QTc prolongation with azole use represents a potential risk factor for cardiac arrhythmias.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Retrospective Cohort Study,
  • Source: 10.1093/ofid/ofae631.1239, PMC11777682
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