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

Article information

Kosin Med J. 2013;28(1):43-47

Publication date (electronic) : 2013 January 19

doi : https://doi.org/10.7180/kmj.2013.28.1.43

Seong Kyu Jeong^,¹, Yeong Hee Ham ¹, Jin Hyuk Jo ¹, Yeong Sin Sin ¹, Dong Heo ¹, Hark Rim ²

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 2012 March 14; 2012 March 26; Accepted 2012 April 02.

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.

Keywords: Escherichia coli; Extended spectrum β; -lactamase; Peritoneal dialysis; Peritonitis

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).

Table 1.

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

ESBL, extended spectrum β-lactamase; MIC, minimum inhibitory contraction