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[Peritonitis due to glycopeptides-resistant Staphylococcus epidermidis].

J Watine¹, M Ciobotaru, D Lombart

¹Laboratoire de biologie polyvalente, Centre hospitalier Puel, Rodez. j.watine@ch-rodenz.fr

Annales De Biologie Clinique

|February 12, 2010

Summary

This case report details a patient with resistant Staphylococcus epidermidis peritonitis during peritoneal dialysis. Rifampicin IP proved effective where vancomycin IP failed, highlighting treatment challenges.

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Area of Science:

Nephrology
Infectious Diseases
Pharmacology

Background:

A 71-year-old male with hypertension and chronic kidney failure on peritoneal dialysis presented with peritonitis.
The patient had a history of dialysis since 2004.

Observation:

The patient developed peritonitis caused by glycopeptide-resistant Staphylococcus epidermidis.
Initial treatment with intraperitoneal (IP) vancomycin did not fully resolve symptoms, with persistent bacteria and white blood cells in dialysis fluid.
Subsequent IP treatment with rifampicin led to complete resolution of clinical and laboratory abnormalities.

Findings:

Laboratory testing showed Staphylococcus epidermidis isolates were susceptible to glycopeptides by disk diffusion but resistant by MIC measurements.
A single measured vancomycin blood concentration was insufficient to determine if sub-inhibitory levels contributed to resistance.
Rifampicin demonstrated efficacy in treating the resistant peritonitis.

Implications:

This case highlights the challenges of managing glycopeptide-resistant bacterial peritonitis in patients undergoing peritoneal dialysis.
It raises questions about optimal monitoring strategies for patients with residual kidney function, including the timing and frequency of vancomycin blood level measurements.
Effective management may require alternative antibiotic strategies beyond standard glycopeptide therapy.