D SABANAYAGAM 1,2, J LI 3, K SUD 2,4
1Western Sydney Local Health District, Sydney, Australia, 2Nepean Local Health District, Sydney, Australia, 3St Vincent’s Hospital, Sydney, Australia, 4School of Medicine, University of Sydney, Sydney, Australia
Aim: To identify risk factors for FP and determinants for compliance with Nystatin prescription.
Background: Fungal peritonitis (FP) is a serious complication of peritoneal dialysis, resulting in irreversible peritoneal membrane failure. Antifungal prophylaxis, such as Nystatin, during the course of concurrent antibiotic therapy may reduce the incidence of FP. The current Western-Sydney-Local-health-district (WSLHD) policy for such scenario involves commencement of oral Nystatin 500,000units 4-times daily for the duration of antibiotic treatment.
Methods: We collected data retrospectively on patient who had developed peritoneal dialysis peritonitis (PDP) between December 2019-Decmber 2020 in WSLHD. We analysed patient’s factors including gender, age, history of diabetes, number of peritonitis episodes in the last 12 months and compliance with Nystatin prescription.
Results: We identified 82 patients who had an episode of PDP, with 9 (11%) patients having FP.
FP patient were less likely to have had complete Nystatin cover when compared to bacterial peritonitis group(44% vs 96%; p<0.05), and more likely to have had ≥2 PDP episodes in the last year (78% vs 30%; p<0.05). There was no significant difference in age (p=0.5), gender (p=0.06) or diabetes history (p=0.6).
In the FP group, only 1 (11%) patient did not receive antibiotics in the month prior to developing FP. 5 (56%) patients developed FP despite appropriate dispensing of Nystatin and 3 (33%) patients were not dispensed Nystatin during a course of antibiotics in the preceding month.
Conclusions: In WSLHD, we cannot demonstrate clear demographic risk factors for development of FP. However, there are significant gaps in compliance of prescribing fungal prophylaxis which might potentially benefit from enhanced clinician-pharmacist communication.
Dharshana is a third year Nephrology Advanced Trainee at Western Sydney and Nepean Local Health Districts, who has a special interest in dialysis