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Vancomycin therapy for treatment of peritonitis in outpatients on peritoneal dialysis
N Yorioka1, Y Taniguchi, T Ito
1Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Abstract:
Vancomycin therapy is frequently used for peritonitis in patients on peritoneal dialysis, but the emergence of resistance has been reported. We evaluated the efficacy of a single intraperitoneal dose of vancomycin for peritonitis in peritoneal dialysis patients. We assessed 24 episodes of peritonitis in 16 patients, and compared clinical parameters between responders and nonresponders. Vancomycin was effective for 12 patients (18 out of 24 episodes, 75.0%). Nonresponders had a significantly higher initial C-reactive protein level and dialysis fluid leukocyte count, and the mean serum albumin over three months before onset was significantly lower than in responders. Patients with a serum albumin level 3.0 g/dl or more were significantly more likely to respond than those with a level less than 3.0 g/dl. In conclusion, it seems reasonable for peritonitis patients with a mild inflammatory response and a serum albumin 3.0 g/dl or more to receive intraperitoneal vancomycin on an outpatient basis.
Insights
Vancomycin effectively treated 75% of peritonitis episodes in peritoneal dialysis patients. Patients with lower inflammation markers and higher serum albumin levels responded better to vancomycin therapy.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a common complication in patients undergoing peritoneal dialysis.
- Vancomycin is a standard treatment for peritonitis, but antibiotic resistance is a growing concern.
Purpose of the Study:
- To evaluate the efficacy of a single intraperitoneal vancomycin dose for treating peritonitis in peritoneal dialysis patients.
- To identify clinical factors associated with treatment response.
Main Methods:
- Retrospective analysis of 24 peritonitis episodes in 16 patients.
- Comparison of clinical parameters between vancomycin responders and nonresponders.
- Assessment of inflammatory markers (C-reactive protein, leukocyte count) and serum albumin levels.
Main Results:
- Vancomycin was effective in 75% of episodes (18/24).
- Nonresponders exhibited higher initial C-reactive protein and dialysis fluid leukocyte counts.
- Lower mean serum albumin levels (<3.0 g/dL) were observed in nonresponders.
- Patients with serum albumin ≥3.0 g/dL showed significantly better response rates.
Conclusions:
- A single intraperitoneal vancomycin dose can be effective for peritonitis in peritoneal dialysis patients.
- Mild inflammatory response and adequate serum albumin levels (≥3.0 g/dL) predict successful outpatient vancomycin treatment.
- This approach may be suitable for select patients, potentially reducing healthcare burden.