Successful antibiotic lock therapy in patients with refractory peritonitis

Area of Science:

• Nephrology
• Infectious Diseases
• Medical Microbiology

Background:

• Peritonitis is a serious complication of peritoneal dialysis (PD).
• Refractory peritonitis, especially from Gram-negative bacteria like Acinetobacter baumannii and Stenotrophomonas maltophilia, poses a significant treatment challenge.
• Standard intraperitoneal antibiotic therapy can be insufficient in cases with suspected catheter biofilm colonization.

Observation:

• Two patients undergoing PD presented with refractory peritonitis attributed to Acinetobacter baumannii and Stenotrophomonas maltophilia.
• These infections persisted despite appropriate systemic and intraperitoneal antibiotic administration.
• Bacterial colonization within the intra-abdominal segment of the PD catheter, forming a biofilm, was hypothesized as the cause of treatment failure.

Findings:

• An adjunct therapy involving the instillation of ceftazidime-heparin lock solution into the PD catheter lumen after each exchange was implemented.
• This antibiotic lock therapy was administered concurrently with systemic antibiotic treatment.
• Successful resolution of the refractory peritonitis was achieved in both patients, leading to infection clearance.

Implications:

• Antibiotic lock therapy represents a promising strategy for managing refractory peritonitis in PD patients.
• This approach may be effective in eradicating infections associated with bacterial biofilms on PD catheters.
• Ceftazidime-heparin lock therapy offers a potential alternative to PD catheter removal in select cases of refractory peritonitis, preserving dialysis access.