Kosin Med J.  2013 Jun;28(1):43-47. 10.7180/kmj.2013.28.1.43.

Extended Spectrum beta-lactamase-producing E. coli-related Nosocomial Peritonitis Treated Successfully with Meropenem in a Patient on Peritoneal Dialysis

• Jeong SK
• Ham YH
• Jo JH
• Sin YS
• Heo D
• Rim H

• KMID: 2308510
• DOI: http://doi.org/10.7180/kmj.2013.28.1.43

Abstract

Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL-producing E.coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.

Keyword

Escherichia coli; Extended spectrum beta-lactamase; Peritoneal dialysis; Peritonitis

MeSH Terms

Anti-Bacterial Agents
Catheters
Dialysis
Escherichia coli
Humans
Imipenem
Peritoneal Dialysis
Peritoneal Dialysis, Continuous Ambulatory
Peritonitis
Recurrence
Staphylococcus aureus
Staphylococcus epidermidis
Thienamycins
Ultrafiltration
Anti-Bacterial Agents
Imipenem
Thienamycins

Figure

• 

  Fig. 1. The clinical evolution of hospital course (x axis is admission date. y axis is dialysate WBC count).

Reference

1.Li PK., Szeto CC., Piraino B., Bernardini J., Figueiredo AE., Gupta A, et al. Peritoneal dialysis related infections recommendations: 2010 update. Perit dial int. 2010. 30:393–423.

2.Kim DK., Yoo TH., Ryu DR., Xu ZG., Kim HJ., Choi KH, et al. Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: a single center's experience over one decade. Perit dial int. 2004. 24:424–32.

3.Nathisuwan S., Burgess DS., Lewis JS 2nd. Extended-spectrum beta-lactamases: epidemiology, detection, and treatment. Pharmacotherapy. 2001. 21:920–8.

4.Palucha A., Mikiewicz B., Gniadkowski M. Diversification of escherichia coli expressing an SHV-type extended-spectrum beta-lactamase (ESBL) during a hospital outbreak: Emergence of an ESBL-hyperproducing strain resistant to expanded-spectrum cephalosporins. Antimicrob Agents Chemother. 1999. 43:393–6.

5.Yip T., Tse KC., Lam MF., Tang S., Li FK., Choy BY, et al. Risk factors and outcomes of extended-spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients. Perit dial int. 2006. 26:191–7.

6.Tedla FM., Salifu M., Friedman EA. Successful treatment of vancomycin-resistant enterococcal peritonitis with linezolid in a kidney transplant patient: a case report and review of the literature. Perit Dial Int. 2004. 24:70–2.

7.Valdes-Sotomayor J., Cirugeda A., Bajo MA., del Peso G., Escudero E., Sanchez-Tomero JA, et al. Increased severity of escherichia coli peritonitis in peritoneal dialysis patients independent of changes in in vitro antimicrobial susceptibility testing. Perit Dial Int. 2003. 23:450–5.

8.Troidle L., Gorban-Brennan N., Kliger A., Finkelstein F. Differing outcomes of gram-positive and gram-negative peritonitis. Am J Kidney Dis. 1998. 32:623–8.

9.Saklayen MG. CAPD peritonitis. Incidence, pathogeng, diagnosis, and management. Med Clin North Am. 1990. 74:997–1010.

10.Park SH., Lee DH., Cho YJ., Cho DK., Shin SK., Kim DJ, et al. Causative organisms and patterns of antibiotics sensitivity of capd peritonitis in different dialysis centers. Korean J Med. 2003. 64:682–9.

11.Colodner R., Rock W., Chazan B., Keller N., Guy N., Sakran W, et al. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis. 2004. 23:163–7.

12.Khurana S., Taneja N., Sharma M. Extended spectrum beta-lactamase mediated resistance in urinary tract isolates of family enterobacteriaceae. Indian J Med Res. 2002. 116:145–9.