1. FUNGAL EXIT SITE INFECTIONS (ESI) AND FUNGAL PERITONITIS (FP) OVER A 20 YEAR PERIOD WITH AND WITHOUT EXIT SITE PROPHYLAXIS Laura Ferreira Provenzano, Heena Sheth, Filitsa Bender, Beth Piraino Renal and Electrolytes Division, University of Pittsburgh Medical Center, PA, USA To study the effects of ESI prophylaxis on fungal infection rates we divided the 20- year period into 3 sub-periods: 1)No prophylaxis 2)Mupirocin at the ES 3) Predominantly gentamicin at the ES This was a retrospective analysis of prospectively collected data from an IRB approved registry with all patients (pts) giving consent. Incident cases within each period were included. Background Objectives/Purpose Methods Summary and Conclusions Results Antibiotics use at the exit site (ES) as routine care reduces the risk of bacterial ESI and peritonitis. However, there is concern this might increase the risk of fungal infections. To study fungal infection rates in a single PD program over a 20-year period and their association with ESI prophylaxis. Study period 1980- 1992 1992- 2001 2001- 2010 P value Incident cases 341183150--- Median age (y) 45.7*50.9*52.7*0.01 Female (%)181(53)99(54.1)77(51.3)ns AA (%)42(12.3)29(15.8)41(27.5) <0.000 1 PD time (mo) 14.113.315.90.024 Table 1. Demographics are shown below: Table 2. Infectious data as % and as rates is shown below: Study period1980-19921992-20012001-2010 Years at risk552181198 Bacterial ESI (epis/y)0.86 1,2 0.58 1,3 0.26 2,3 Bacterial P (epis/y)0.77 4,5 0.52 4,6 0.28 5,6 Fungal ESI (% of pts) 2 (0.58)0 (0)3 (2) Fungal P (% of pts)4 (1.2)4 (2.19)4 (2.7) Fungal ESI (epis/y)0.0036 7 0808 0.015 7,8 Fungal P (epis/y)0.007 9,10 0.022 9 0.02 10 1 p=0.0001; 2 p<0.0001; 3 p<0.0001; 4 p<0.0001; 5 p<0.0001; 6 p=0.0003; 7 p=0.069; 8 p=0.07; 9 p=0.07; 10 p=0.08 In summary, fungal infections in our program are extremely uncommon. The use of a broader spectrum ATB (gentamicin) for routine ES care was associated with a striking reduction in bacterial peritonitis and an insignificant increase in fungal infections. We recommend the use of gentamicin at the exit site for all PD patients.

2. Study period 1980- 1992 1992- 2001 2001- 010 P value Incident cases 341183150--- Median age (y) 45.7*50.9*52.7*0.01 Female (%) 181(53)99(54.1)77(51.3)ns AA (%)42(12.3)29(15.8)41(27.5) <0.000 1 PD time (mo) 14.113.315.90.024 Study period1980-19921992-20012001-2010 Years at risk552181198 Bacterial ESI (epis/y)0.86 1,2 0.58 1,3 0.26 2,3 Bacterial P (epis/y)0.77 4,5 0.52 4,6 0.28 5,6 Fungal ESI (% of pts)2 (0.58)0 (0)3 (2) Fungal P (% of pts)4 (1.2)4 (2.19)4 (2.7) Fungal ESI (epis/y)0.0036 7 0808 0.015 7,8 Fungal P (epis/y)0.007 9,10 0.022 9 0.02 10

4. % responses