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Expanded-spectrum β-lactamase producing Klebsiella pneumoniae-related peritonitis in a patient on peritoneal dialysis
- Source :
- American Journal of Kidney Diseases. 44:e102-e106
- Publication Year :
- 2004
- Publisher :
- Elsevier BV, 2004.
-
Abstract
- While hospitalized for pneumonia with ventilator-dependent respiratory failure, a 45-year-old man on continuous ambulatory peritoneal dialysis (CAPD) had nosocomial peritonitis secondary to infection by expanded spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-Kp). He was treated successfully with a 3-week course of intraperitoneal (IP) flomoxef therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy. The International Consensus Panel recommends IP ceftazidime as the treatment of choice for CAPD patients suffering Klebsiella species-related peritonitis. However, the most appropriate form of IP antibiotic therapy and the outcomes for expanded-spectrum beta-lactamase (ESBL)-producing bacteria-related peritonitis for CAPD patients have not been established yet. Further, the ability to correctly report minimal inhibitory concentrations (MICs) of ceftazidime for ESBL bacteria in the resistant range varies between laboratories, making the diagnosis of ESBL-Kp-related CAPD peritonitis more complex and difficult. Thus, it appears reasonable to suggest that its incidence is probably underestimated and its significance ignored. The authors suggest that a 3-week IP treatment with flomoxef, a synthesized oxacephem, with loading and maintenance doses of 250 and 125 mg/L, respectively, is effective and safe for ESBL-Kp-related peritonitis in these patients. ESBL producing bacterial infection should be considered as a possible cause of overt CAPD-related peritonitis. Early detection of ESBLB pathogens and institution of effective antibiotic treatment may improve the prognosis.
- Subjects :
- Male
medicine.medical_specialty
Klebsiella pneumoniae
medicine.medical_treatment
Ceftazidime
Peritonitis
beta-Lactamases
Peritoneal dialysis
chemistry.chemical_compound
Bacterial Proteins
Peritoneal Dialysis, Continuous Ambulatory
Internal medicine
medicine
Humans
Intensive care medicine
Dialysis
Oxacephem
biology
business.industry
Continuous ambulatory peritoneal dialysis
Middle Aged
biology.organism_classification
medicine.disease
Klebsiella Infections
chemistry
Nephrology
Flomoxef
business
medicine.drug
Subjects
Details
- ISSN :
- 02726386
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- American Journal of Kidney Diseases
- Accession number :
- edsair.doi.dedup.....d3948aec55799b3e4e4fd9e2b0e102d9