Extended spectrum beta lactamase peritonitis: Time for innovation?

Extended spectrum beta lactamase (ESBL) producing bacteria that are capable of hydrolyzing even third generation cephalosporin are emerging as a potent threat. We report a seven-year-old child on continuous ambulatory peritoneal dialysis, who developed ESBL producing Klebsiella pneumoniae peritonitis. The bacterium was resistant to the usual intraperitoneal antibiotics. We successfully treated the child with intravenous meropenem along with oral cotrimoxazole. The case highlights the menace of ESBL peritonitis, as also a need for the development of guidelines for such a scenario, which is becoming increasingly common in India.