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Successful use of intraperitoneal daptomycin in the treatment of vancomycin-resistant enterococcus peritonitis

Sarah C Huen1, Isaac Hall, Jeffrey Topal

  • 1Section of Nephrology, Yale School of Medicine, New Haven, CT, USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|February 25, 2009
PubMed

Insights

Intraperitoneal daptomycin effectively treated vancomycin-resistant enterococcus peritonitis in two patients undergoing peritoneal dialysis. This approach offers a promising solution for challenging infections, showing no relapse in treated cases.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Peritoneal dialysis-associated peritonitis is a growing concern, particularly infections caused by antibiotic-resistant organisms like vancomycin-resistant enterococci (VRE).
  • Treating VRE peritonitis in patients on peritoneal dialysis presents significant clinical challenges due to limited effective therapeutic options.

Observation:

  • Two cases of vancomycin-resistant Enterococcus faecium peritonitis in patients on automated peritoneal dialysis are presented.
  • Both patients received intraperitoneal daptomycin for 10-14 days via manual dialysate exchanges every 4 hours.

Findings:

  • Intraperitoneal daptomycin successfully cleared VRE peritonitis in both patients, despite known daptomycin degradation in dextrose solutions.
  • No relapse or recurrent peritonitis was observed in either patient following treatment.
  • The treatment regimen involved 10-14 days of intraperitoneal daptomycin administered every 4 hours.

Implications:

  • Intraperitoneal daptomycin represents a viable and effective treatment strategy for vancomycin-resistant enterococcus peritonitis in peritoneal dialysis patients.
  • Further research into optimal dosing and pharmacokinetics of intraperitoneal daptomycin is warranted for this patient population.
  • This study highlights a potential therapeutic avenue for managing difficult-to-treat resistant bacterial peritonitis.

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