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Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes - a
Kristina Boss1, Ina Wiegard-Szramek2, Jan Dziobaka3
1Department of Nephrology, University Hospital Essen, University-Duisburg Essen, 45147, Essen, Germany. Kristina.boss@uk-essen.de.
Background:
Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination.
Case Presentation:
A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal.
Conclusion:
This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.
Insights
Peritoneal dialysis (PD)-related peritonitis caused by Listeria monocytogenes can be effectively treated with ampicillin. This case report highlights successful treatment using both intravenous and intraperitoneal ampicillin, establishing effective serum concentrations.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritoneal dialysis (PD)-related peritonitis is a serious complication with high morbidity and mortality.
- Listeria monocytogenes is an uncommon but potential cause of PD-peritonitis.
- Optimal ampicillin treatment (route, dose, duration) for Listeria infections remains undefined.
Observation:
- A 72-year-old male patient with end-stage renal disease on PD presented with Listeria monocytogenes peritonitis.
- Initial treatment involved high-dose intravenous ampicillin, which partially reduced leukocyte counts in PD effluent.
- Addition of intraperitoneal ampicillin achieved complete resolution of peritonitis, with effective serum concentrations monitored for both administration routes.
Findings:
- This report details the successful treatment of PD-associated Listeria monocytogenes peritonitis using a combination of intravenous and intraperitoneal ampicillin.
- It demonstrates the feasibility of using intraperitoneal ampicillin for Listeria peritonitis in PD patients.
- Peripheral serum ampicillin concentrations can be effectively monitored to guide treatment.
Implications:
- This case provides evidence for a novel therapeutic regimen for Listeria peritonitis in PD patients.
- It suggests that intraperitoneal ampicillin, alongside intravenous administration, can be a viable treatment option.
- Further research is warranted to establish definitive dosing and duration guidelines for ampicillin in treating PD-related Listeria infections.
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