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. 2022 May 24;17(5):e0268823.
doi: 10.1371/journal.pone.0268823. eCollection 2022.

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

Talerngsak Kanjanabuch  1   2   3   4 , Tanawin Nopsopon  5 , Tanittha Chatsuwan  6   7 , Sirirat Purisinsith  8 , David W Johnson  9   10   11 , Nibondh Udomsantisuk  6 , Guttiga Halue  12 , Pichet Lorvinitnun  13 , Pongpratch Puapatanakul  1   3 , Krit Pongpirul  5 , Ussanee Poonvivatchaikarn  14 , Sajja Tatiyanupanwong  15 , Saowalak Chowpontong  16 , Rutchanee Chieochanthanakij  17 , Oranan Thamvichitkul  18 , Worapot Treamtrakanpon  19 , Wadsamon Saikong  20 , Uraiwan Parinyasiri  21 , Piyatida Chuengsaman  22 , Phongsak Dandecha  23 , Jeffrey Perl  24 , Kriang Tungsanga  1 , Somchai Eiam-Ong  1 , Suchai Sritippayawan  25 , Surasak Kantachuvesiri  26 ; Advisory Board of Peritoneal Dialysis, Nephrology Society of Thailand
Affiliations

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

Talerngsak Kanjanabuch et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient flow diagram.
Fig 2
Fig 2. Seasonal variation in the prevalence of fungal peritonitis episode according to fungal type by wet smear.
Fig 3
Fig 3. Kaplan-Meier curves comparing patient survival according to different types of fungal peritonitis.
See this image and copyright information in PMC

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