Does antifungal prophylaxis with daily oral fluconazole reduce the risk of fungal peritonitis in peritoneal dialysis patients? The Pan Thames Renal Audit

Background and Objectives: Fungal peritonitis increases the risk of transfer to haemodialysis and mortality. Methods: We audited the effect of co-prescription of daily oral fluconazole with antibiotics in the Pan Thames centres on fungal peritonitis. Results: We found 49 (1.5%) fungal peritonitis cases in 3,322 episodes of peritonitis. Two centres co-prescribed prophylactic fluconazole with antibiotics, with a fungal peritonitis rate of 0.0032/patient year, compared to 0.0099 from centres not using prophylaxis. However, centres using fungal prophylaxis had lower peritonitis rates of 0.036, compared to 0.05 for the other centres. Correcting for background peritonitis rates, there was no significant difference in the incidence of fungal peritonitis. Conclusions: In centres with a low incidence of fungal peritonitis, additional co-prescription of fluconazole with antibiotics appeared to reduce the risk of fungal peritonitis. However, variation in practice between centres is the main determinant of the observed incidence of fungal peritonitis rather than the use of antifungal prophylaxis.