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Case Report
Extended Spectrum β-lactamase–producingE. coli -related Nosocomial Peritonitis Treated Successfully with Meropenem in a Patient on Peritoneal Dialysis - Seong Kyu Jeong1, Yeong Hee Ham1, Jin Hyuk Jo1, Yeong Sin Sin1, Dong Heo1, Hark Rim2
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Kosin Medical Journal 2013;28(1):43-47.
DOI: https://doi.org/10.7180/kmj.2013.28.1.43
Published online: January 19, 2013
1Department of internal medicine, Daedong Hospital, Busan, Korea
2Department of nephrology medicine, Kosin University Gospel Hospital, Busan, Korea
- Corresponding author: Seong Kyu Jeong, Department of internal medicine, Daedong Hospital, 187, Chungnyeol-daero, Dongnae-gu, Busan, Korea TEL: +82-10-9650-2666 FAX: +82-51-553-7575 E-mail: sk-jeong82@hanmail.net
• Received: March 14, 2012 • Accepted: April 2, 2012
Copyright © 2013 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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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.
Fig. 1.The clinical evolution of hospital course (x axis is admission date. y axis is dialysate WBC count).
Table 1.Sensitivity pattern for extended spectrum β-lactamase Escherichia coli strain
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Fig. 1. The clinical evolution of hospital course (x axis is admission date. y axis is dialysate WBC count).
Fig. 1.
Extended Spectrum β-lactamase–producing E. coli -related Nosocomial Peritonitis Treated Successfully with Meropenem in a Patient on Peritoneal Dialysis
Sensitivity pattern for extended spectrum β-lactamase Escherichia coli strain
| Sensitivities | Antibiotic | MIC (μg/mL) |
|---|---|---|
| Sensitive | Imipenem | < 1 |
| Meropenem | < 0.25 | |
| Intermediate | Amoxicillin | 16 |
| Persistant | Piperacillin | > 1.28 |
| Ampicillin | > 32 | |
| Cefoxitin | > 64 | |
| Cefotaxime | > 64 | |
| Ceftazidime | > 4 | |
| Cefefime | > 8 | |
| Aztreonam | > 16 | |
| Levofloxacin | > 8 |
Table 1. Sensitivity pattern for extended spectrum β-lactamase Escherichia coli strain
ESBL, extended spectrum β-lactamase; MIC, minimum inhibitory contraction
