Medical resolution of refractory peritoneal dialysis-associated peritonitis without catheter removal

A man in his 60s presented with Escherichia coli peritoneal dialysis (PD)-associated peritonitis. Despite appropriate therapy, his effluent leucocyte count, though downward trending, remained >2000/µL on day 5, meeting criteria for refractory peritonitis and prompting recommendation for PD catheter removal. This option was declined by the patient because of his poor premorbid condition and high procedural risk. As treatment continued, a steady further downward trend in effluent leucocytes emerged, and catheter preservation was pursued. Intraperitoneal amikacin was added to intravenous ceftriaxone, providing dual-route, dual-class antimicrobial therapy. Unexpectedly, his peritonitis resolved by day 15 without catheter removal. He was discharged eventually.This case illustrates that PD catheter removal may not always be practical in frail patients. Trends in effluent leucocyte counts may offer more clinical insight than a strict absolute threshold for catheter removal. It raises the hypothesis that combined intravenous and intraperitoneal antibiotics may be beneficial in selected gram-negative infections.