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Successful Treatment of PD Peritonitis Due to Brevundimonas vesicularis

Daniel Christiadi1, Richard F Singer1,2, Darren M Roberts3,2

  • 1Renal Medicine, The Canberra Hospital, Garran, ACT, Australia.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|September 7, 2018
PubMed

Insights

Brevundimonas vesicularis peritonitis in peritoneal dialysis patients can be successfully treated with a 21-day antibiotic regimen. However, drug levels in dialysis fluid suggest suboptimal antibiotic concentrations, warranting further study.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Microbiology

Background:

  • Peritoneal dialysis (PD)-associated peritonitis is a serious complication.
  • Brevundimonas vesicularis is an uncommon pathogen causing PD peritonitis, with previous reports indicating poor outcomes.

Observation:

  • This report details a successful treatment of PD peritonitis caused by Brevundimonas vesicularis.
  • The patient received a 21-day intraperitoneal (IP) antibiotic course, adapting a regimen used for Pseudomonas aeruginosa.

Findings:

  • The treatment involved IP gentamicin for 10 days, followed by IP cefepime and oral ciprofloxacin for 11 days.
  • Despite a favorable clinical outcome, antibiotic concentrations in PD effluent were below targets for maximal bacterial kill for cefepime and possibly ciprofloxacin.

Implications:

  • This case demonstrates a viable antibiotic strategy for rare PD peritonitis pathogens.
  • Therapeutic drug monitoring may be crucial for optimizing antibiotic efficacy in PD peritonitis to improve patient outcomes.
Keywords:
Peritoneal dialysisantibioticguidelinespharmacokineticstherapeutic drug monitoring

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