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[Treatment of peritonitis in continuous ambulatory peritoneal dialysis with intraperitoneal ceftriaxone]
J M Ragnaud1, M C Bezian, M Dupon
1Clinique Médicale et des Maladies Infectieuses, Hôpital Pellegrin, Bordeaux.
Abstract:
In 16 patients under CAPD, 29 cases of bacterial peritonitis were observed, with clinical manifestations in 23. The mean cell count in peritoneal dialysis fluid was 5608/mm3 with 4991/mm3 polymorphonuclear, Leukocytes Causative pathogens were Staphylococcus in 14 cases, Streptococcus in 6, Bacillus in one, Enterobacteria in 5, Pseudomonas aeruginosa in 1 and Moraxella in 1. Three cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g of ceftriaxone. 79.3% of patients recovered within 5 days. Failure were due to a Methicillin-resistant Staphylococcus epidermidis in one case, a Streptococcus faecalis in two cases, and a Staphylococcus aureus in three observations, which two were responsible of abscess round catheter peritoneal. Mean ceftriaxone concentrations 24 hours after the intraperitoneal injection were 50.6 mg/l (range: 3.3-141 mg/l) in serum and 58.1 mg/l (range: 4.3-180 mg/l) in dialysate. These concentrations are greater than most of ceftriaxone's MICs for susceptible bacteria, a finding that confirm the value of treatment with a single daily intraperitoneal injection of ceftriaxone.
Insights
Daily intraperitoneal ceftriaxone effectively treats bacterial peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Most infections resolved within five days, demonstrating ceftriaxone
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Bacterial peritonitis is a significant complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Prompt and effective treatment is crucial to prevent serious outcomes and maintain dialysis functionality.
Purpose of the Study:
- To evaluate the efficacy and safety of a single daily intraperitoneal injection of ceftriaxone for treating bacterial peritonitis in CAPD patients.
- To determine the pharmacokinetic profile of ceftriaxone in serum and dialysate following intraperitoneal administration.
Main Methods:
- Observational study involving 16 CAPD patients with 29 episodes of bacterial peritonitis.
- Analysis of clinical manifestations, peritoneal dialysis fluid cell counts, and causative pathogens.
- Treatment with 1g daily intraperitoneal ceftriaxone; monitoring of patient recovery and drug concentrations.
Main Results:
- Causative pathogens included Staphylococcus, Streptococcus, Enterobacteria, Pseudomonas aeruginosa, and Moraxella.
- 79.3% of patients recovered within 5 days of treatment.
- Mean 24-hour serum and dialysate ceftriaxone concentrations exceeded the minimum inhibitory concentrations (MICs) for susceptible bacteria.
Conclusions:
- A single daily intraperitoneal injection of 1g ceftriaxone is an effective first-line treatment for bacterial peritonitis in CAPD patients.
- Achieved drug concentrations support the therapeutic value of this dosing regimen.
- Treatment failures were associated with specific resistant organisms and complications like abscess formation.