POS-694 THE ROLE OF INTRAPERITONEAL AMPHOTERICIN B IN PERITONEAL DIALYSIS-RELATED FUNGAL PERITONITIS. EXPERIENCE FROM A MALAYSIAN CENTER

Fungal peritonitis (FP) is an uncommon complication of peritoneal dialysis (PD) and is associated with high mortality and technique failure rate. The optimal treatment for FP is still not well established and intraperitoneal (IP) amphotericin B has been reported to cause chemical peritonitis. This study aims to investigate the role of IP amphotericin B in treating FP and the factors affecting the outcomes of FP. Outcomes of all FP diagnosed between January 1, 2011 and March 30, 2021 were reviewed retrospectively. Before January 2015, FP cases were treated with intravenous (IV) amphotericin B and oral flucytosine; from January 2015 onwards, IP amphotericin B was given in additional to the standard antifungal regimen. During the study period, 48 FP cases were diagnosed. Yeast was isolated from 77% of the cases with Candida parapsilosis (29%) the most frequently detected yeast. The susceptibility of yeast isolates to amphotericin B and flucytosine were 96% and 100%, respectively. On average, Tenckhoff catheter was removed 14 days from the diagnosis of FP. The overall PD resumption rate was 44%, similar among patients who did/did not receive IP amphotericin B (44% vs 43%, P=0.94). The technique failure rate after 12 months was similar among those who did/did not receive IP amphotericin B (81% vs 79%, P=0.83). Overall mortality was 19%, similar between those who did/did not receive IP amphotericin B (21% vs 14%, P=0.61). Mortality was also similar between those who were infected by yeast and mold (19% vs 18%, P=0.96) and those who had Tenckhoff catheter removed early (≤1 week) and late (>1 week) from the diagnosis of FP (18% vs 19%, P=0.89). Mortality was higher among those with serum albumin ≤25 g/L (35% vs 8%, P=0.02). None suffered from chemical peritonitis with IP amphotericin B. Even though IP amphotericin did not cause chemical peritonitis, it did not seem to improve the outcomes of FP. Hypoalbuminemia was associated with higher mortality in patients with FP.