ABSTRACT
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.
Subject(s)
Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Listeriosis/drug therapy , Peritoneal Dialysis/adverse effects , Peritonitis/drug therapy , Aged , Humans , Leukocyte Count , Listeria monocytogenes , Listeriosis/etiology , Male , Peritonitis/etiologyABSTRACT
OBJECTIVE DESIGN: We describe a case series of patients colonized with KPC-producing Enterobacteriaceae related to dialysis drains at patient's bedside. SETTING: The study was set at the intensive care unit (ICU) of a tertiary referral hospital. PATIENTS: In March 2016, we discovered four ICU patients to be colonized with KPC-producing Enterobacteriaceae in routine screening. All of these patients had already received contact isolation, and all of them were treated with continuous veno-venous dialysis. Environmental examinations showed KPC-producing Enterobacteriaceae in dialysis drains in different ICU rooms and even in rooms not hosting KPC-colonized patients. INTERVENTIONS: Based on our findings, we suspected the dialysis drains as a reservoir of KPC-producing Enterobacteriaceae with a potential risk for the patients. Therefore, we decided to change the dialysis waste management. RESULTS: As a result, no KCP-producing Enterobacteriaceae were detected during the following weekly screening of the patients. CONCLUSIONS: Installation of dialysis connection units including a drain system at the patient's bedside is a comfortable way to provide water supply. In many ICUs, such dialysis drains are installed near the patients' head and directly besides the infusion systems. When the drains are not used properly, in our opinion, they pose a risk of transmission of pathogens from the drain to the patient. Our findings support the need of specific precautions.
