COMPLIANCE WITH ANTIFUNGAL PROPHYLAXIS IN PD PERITONITIS - RESULTS FROM A SINGLE UK CENTRE WITH A QUALITY IMPROVEMENT INITIATIVE APPROACH

Introduction:

Peritonitis poses a significant risk in peritoneal dialysis (PD) patients, necessitating timely intervention to prevent systemic infections and preserve peritoneal membrane integrity. 

Fungal peritonitis, due to its resistance to standard anti-microbial therapies, presents a particular challenge. The International Society for peritoneal dialysis (ISPD) guidelines therefore recommend antifungal prophylaxis in PD patients to mitigate the risk of fungal peritonitis (ISPD Guidelines 2020). 

Compliance with these guidelines is crucial to improving patient outcomes. We have investigated compliance with the ISPD guideline at our centre as well as look for reasons for non-compliance.

Methods:

Retrospective analysis of all peritonitis episodes were done between January 2022 to June 2024. 

Demographic information and prescription details were obtained from electronic medical records (PICS) and other unit patient records.

The number of patients who did not have co-prescription of antifungals was determined.

Results:

164 episodes of peritoneal-dialysis associated peritonitis were reported over the study period. There were no reported cases of refractory peritonitis. However, 36 repeat peritonitis episodes were noted which accounted for 22% of cases. Recurrent peritonitis accounted for 4% episodes and relapse peritonitis 4%. 3 episode of PD catheter insertion related peritonitis was encountered in the study period. 

Gram positive organisms were the most common causative agents, causing 50% of cases , Gram negative 20% , fungus 1.2% and acid-fast bacilli 1.2%. 12.8% of the peritonitis cases had negative cultures. 10.9% episodes had polymicrobial growths. 50% of fungal peritonitis cases were secondary.

 There were 27 patient dropouts. 78% of these were converted to HD, 12% had renal transplantation and 10% were peritonitis associated deaths. Both patients who developed fungal peritonitis had their PD catheters removed and were converted to HD. The average time to first peritonitis episode was 29 months.

Conclusions:

Several studies have shown secondary fungal peritonitis to occur following antibiotic treatment. Co-prescription of prophylactic antifungals alongside antibiotics has been shown to be effective in the prevention of secondary fungal peritonitis as recommended by ISPD the guidelines. 

At present, our hospital guidelines do not recommend routine anti-fungal prophylaxis co-prescription. At our hospital, fungal peritonitis was rare. However, prophylactic anti fungal co-prescription was suboptimal. The clinical records did not clarify why antifungals were not prescribed. 

An educational campaign is planned to increase awareness and improve adherence to antifungal prophylaxis guidelines. We also plan to improve documentation to include reasons why antifungals are not prescribed if that is the case.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.