Once-Daily Intraperitoneal Gentamicin is Effective Therapy for Gram-Negative Capd Peritonitis

Abstract

Objective To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Design A prospective cohort study in prevalent CAPD patients. Setting A tertiary care institution. Patients All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis. Main Outcome Measures Results of microbiological cultures and clinical outcomes of peritonitis were analyzed. Results Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded. Conclusions Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

“…At the dosage currently recommended, the peak gentamicin concentration in dialysis solution is at least 8 times the minimal inhibitory concentration (MIC) of the likely pathogens ( 315 ). Two studies showed that once-daily gentamicin is as effective as continuous dosing for CAPD patients ( 256 , 316 ). However, systemic absorption of intermittent IP gentamicin is highly variable and depends on the peritoneal transport characteristics ( 315 ), and the high systemic absorption of gentamicin in patients with peritonitis and prolonged plasma elimination half-life may lead to systemic accumulation and subsequent toxicity ( 315 ).…”

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

“…Some studies have shown that intermittent dosing of IP vancomycin and gentamicin is as effective as continuous dosing in CAPD patients. 22 , 27 , 28 Although in our center we use intermittent dosing of IP ceftazidime, 2 pharmacokinetic studies demonstrated that a once-daily IP administration of ceftazidime at a dose of 15 to 20 mg/kg can result in subtherapeutic blood levels. To achieve a therapeutic level of ceftazidime, a recommended loading dose of 3 g with maintenance dosing of 1 to 2 g every 24 hours is suggested.…”

Escherichia Coli Peritonitis in Peritoneal Dialysis: The Prevalence, Antibiotic Resistance and Clinical Outcomes in a South China Dialysis Center

“…While it has been widely recognized that gram-negative peritonitis, as a whole, is associated with poor outcomes (3), E. coli peritonitis carries an interesting variability in its severity, from relatively favorable outcomes (19,20) to a high incidence of treatment failure despite apparently appropriate antibiotic treatment (11). This notion is further supported by the present study, since the clinical outcomes of E. coli peritonitis in our study were generally better than those reported by Yip et al (21), who examined 153 episodes of monomicrobial E. coli peritonitis that occurred between 1995 and 2009 in a single center in Hong Kong.…”