Abstract
BackgroundPeritoneal 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 presentationA 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.ConclusionThis 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.
Highlights
Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates
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
PD-related peritonitis is most commonly caused by gram-positive bacteria, such as Staphylococcus epidermidis or Staphylococcus aureus [2], but infection with Listeria monocytogenes may occur [3]
Summary
Peritoneal dialysis (PD) is an established method of renal replacement therapy. PD-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. We report a case of PD-associated peritonitis due to L. monocytogenes infection that was managed with ampicillin administered intravenously and intraperitoneally, separately and in combination. Urine, and PD effluent samples for microbiological analysis, we initiated antibiotic therapy because analysis of ambulatory PD effluent detected L. monocytogenes. We collected further samples at two and 4 h after the dose of intravenous antibiotic, and tests showed sufficient serum ampicillin levels of 235 mg/L at 2 h and 95.5 mg/dL at 4 h. The antibiotic-containing dialysate was drawn into the peritoneal cavity and allowed to dwell for 12 h With this combination of intravenous and intraperitoneal antibiotic therapy, the leukocyte count in the PD effluent declined permanently. After the PD leukocyte count had been lower than 100/nL for 7 days, we discontinued antibiotic therapy on day 21 and discharged the patient from the hospital.
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