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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.
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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