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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
PubMed

Insights

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.

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.

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