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Once-daily intraperitoneal gentamicin is effective therapy for gram-negative CAPD peritonitis
W C Lye1, J C van der Straaten, S O Leong
1Mount Elizabeth Medical Centre, Department of Medicine, National University Hospital, Singapore, Singapore.
Objective:
To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis.
Design:
A prospective cohort study in prevalent CAPD patients.
Setting:
A tertiary care institution.
Patients:
All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis.
Main Outcome Measures:
Results of microbiological cultures and clinical outcomes of peritonitis were analyzed.
Results:
Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded.
Conclusions:
Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.