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Fungal peritonitis in the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative

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Abstract

Background

Fungal peritonitis is a serious complication among peritoneal dialysis (PD) patients. The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multicenter quality improvement initiative with the primary aim to reduce catheter-related infections in children on chronic dialysis.

Objective

To describe the epidemiology of fungal peritonitis and outcomes of affected patients among pediatric subjects receiving chronic PD and enrolled in SCOPE.

Methods

Data pertaining to PD characteristics, peritonitis episodes and patient outcome were collected between October 2011 and September 2015 from 30 pediatric dialysis centers participating in the SCOPE collaborative. Peritonitis-related data were stratified by etiology, fungal versus bacterial/culture-negative peritonitis. Differences among groups were assessed by Chi-square analysis.

Results

Of 994 patients enrolled in the registry, there were 511 peritonitis episodes of which 41 (8.0%) were fungal. Thirty-six individual patients with 39 unique catheters accounted for the fungal peritonitis episodes. Twenty-three (59%) of the episodes occurred in patients aged < 2 years (p = 0.03). Fungal peritonitis was the initial episode of peritonitis in 48.8% of affected patients, and only 17.1% of these patients had had a previous peritonitis episode within 30 days of the fungal infection. Insertion of the PD catheter at < 2 years of age was associated with an adjusted odds ratio of 2.8 (95% confidence interval 1.24, 6.31) for development of fungal peritonitis compared to older children (p = 0.01). Fungal peritonitis was associated with an increased rate of hospitalization (80.5 vs. 63.4%; p = 0.03), increased length of hospitalization (median of 8 vs. 5 days; p < 0.001) and increased rates of catheter removal (84.6 vs 26.9%; p = 0.001) and technique failure (68.3 vs. 8%; p = 0.001) compared to other causes of peritonitis.

Conclusion

Fungal infections were responsible for 8.0% of peritonitis episodes in the SCOPE collaborative, with the majority of fungal peritonitis episodes occurring in children aged < 2 years. Although no risk factors for infection other than young age were identified, fungal peritonitis was associated with an increased risk of hospitalization, longer hospital stay and an increased frequency of technique failure.

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Author information

Authors and Affiliations

  1. Pediatric Nephrology, Seattle Children’s, Seattle, WA, USA

    Raj Munshi

  2. Pediatric Nephrology, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA

    Christine B. Sethna

  3. Biostatistics, Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson & Jonathan Rodean

  4. Pediatric Nephrology, Driscoll Children’s Hospital, Corpus Christi, TX, USA

    Samhar Al-Akash

  5. Pediatric Nephrology, University of Louisville, Louisville, KY, USA

    Sushil Gupta

  6. Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alicia M. Neu

  7. Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

Authors
  1. Raj Munshi
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  2. Christine B. Sethna
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  3. Troy Richardson
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  4. Jonathan Rodean
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  5. Samhar Al-Akash
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  6. Sushil Gupta
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  7. Alicia M. Neu
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  8. Bradley A. Warady
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Corresponding author

Correspondence to Raj Munshi.

Ethics declarations

The Institutional Review Board (IRB) at each participating center approved the collaborative protocol and informed consent was obtained where required by the institution’s IRB.

Conflict of interest

The authors declare no conflict of interest.

Appendix

Appendix

Table 5 Participating centers that contributed data to the SCOPE Collaborative
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Munshi, R., Sethna, C.B., Richardson, T. et al. Fungal peritonitis in the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative. Pediatr Nephrol 33, 873–880 (2018). https://doi.org/10.1007/s00467-017-3872-4

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  • DOI: https://doi.org/10.1007/s00467-017-3872-4

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