Intraperitoneal Administration Of Vancomycin Research Articles

Vancomycin flushing reaction after intraperitoneal vancomycin: A case report.

Vancomycin has been reported to cause vancomycin flushing reaction (VFR), a hypersensitivity reaction that mostly occurs after intravenous administration. The incidence of VFR in a patient receiving intraperitoneal vancomycin is rare. We report a case of a female peritoneal dialysis (PD) patient with a PD-related peritonitis who developed VFR after intraperitoneal administration of 2000 mg vancomycin. Seventy-five minutes after instillation, she developed flushing, a pruritic erythema on the upper body and swelling of the lips. Blood results revealed a vancomycin plasma concentration of 54.8 mg/L and a normal tryptase level. During a relapse of her PD-related peritonitis, vancomycin was successfully reintroduced in a 50% reduced dose. No symptoms of VFR developed, and the corresponding vancomycin plasma concentration was 33.6 mg/L. Intraperitoneal treatment was continued with 500 mg vancomycin every 2-3 days with frequently measured, adequate trough levels ranging from 15-22 mg/L. This case illustrates the risk factors for the development of VFR after intraperitoneal administration of vancomycin, namely a high and concentrated loading dose together with a low body weight, a fast peritoneal transport state and peritonitis. Reintroduction of vancomycin after occurrence of VFR is safe, but a lower loading dose or a slower instillation rate is recommended.

Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis.

Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients. Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25–35 mg/l at the peak moment and 4–8 mg/l at the trough moment; and after 48 h for vancomycin, 15–20 mg/l at the trough moment. Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39). Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

P1188ICODEXTRIN-INDUCED CHEMICAL PERITONITIS IN A PATIENT WITH CARDIORENAL SYNDROME

Abstract Background and Aims The main cause of morbidity among patients who undergo peritoneal dialysis (PD) remains peritonitis. However there are rare references in published literature about the development of sterile peritonitis related to exposure to PD materials used to overcome the complications from glucose solutions.The objective of the present case report is to enhance clinical suspicion in order to avoid unnecessary antibiotic treatment or catheter removal. Case description A 56-year-old male became dialysis dependent from June 2017 due to cardiorenal syndrome type II, after multiple hospitalizations for pulmonary edema within a year. The patient was prescribed icodextrin 7,5% as a single 10-hour nocturnal dwell with dry day period in continuous ambulatory PD .At his scheduled appointment during drainage of the nighttime dialysate, slightly cloudy effluent with a lot of pale yellow substances “sesame” like, were observed without any signs of peritonitis or pathology from the Catheter exit site based on Twardowski classification.The dialysate contained 600 cells/ml. The floating yellow substances after laboratory and light microscopy examination accumulated epithilium cells with rare macrophages were found.Due to these findings,icodextrin was discontinued and empiric antibiotic therapy started including intraperitoneal administration of vancomycin and ceftazidime .After 3 days the floating substances disappeared and the number of cells in dialysate progressively decreased but not within the normal range so empirical antifungal therapy was decided. Daily repeated aerobic, anaerobic and fungal cultures of effluent and blood were negative as well the culture of exit site. ADA (adenosine deaminase test) and β-koch culture were also negative. Computed tomography scan of abdomen and colonoscopy showed no pathology.Due to fluid overload an additional long-term dwell of icodextrin solution was initiated.The re-exposure doubled the number of cells (310 cells/ml) and a second sample was sent for cytological examination which showed plenty of hyperplastic mesothelial cells in piles and isolated, abundant mature lymphocytes, few polymorphonuclear leukocytes as well as several mast cells. Based on these observations peritoneal cavity remained empty for 24 hours. Afterwards a 4-hour exchange of glucose-containing solution of 1,36%, 2,27%, 3,86% and finally of icodextrin was held once daily. The cells were 155, 120, 105 and 450/ml respectively with lymphocytes and mast cells being predominant.Based on these data, it was considered that the exposure to icodextrin produced hypersensitivity and the empiric antibiotic therapy was discontinued.The catheter was removed and sent for culturing which was negative.The biopsy of peritoneal membrane revealed mild fibrous sclerotic lesions, fibrous texture, partially collagenized membrane lacking mesothelial lining and exhibiting sparse chronic nonspecific inflammatory infiltration involving rare neutrophilic leukocytes. Plenty of small blood vessels were observed, with no immunomorphological features including IgG4 staining. These findings were attributed to chemical peritonitis from icodextrin solution ant the patient switched dialysis modality. Discussion:the use of icodextrin in peritoneal dialysis patients has numerous advantages over glucose-based dialysates including improved ultrafiltration, better fluid control and less hypertension, especially in patients with cardiorenal syndrome. In the face of evident benefits, clinicians should, however, be aware of the potential of icodextrin to induce chemical sterile peritonitis.

Micrococcus aloeverae - A Rare Cause of Peritoneal Dialysis-Related Peritonitis Confirmed by 16S rRNA Gene Sequencing.

The number of patients receiving peritoneal dialysis has increased worldwide. Herein, we report the first case to our knowledge of continuous ambulatory peritoneal dialysis (CAPD) peritonitis caused by Micrococcus aloeverae, which was initially reported to be caused by Micrococcus luteus in the dialysate culture report but later identified by 16S ribosomal ribonucleic acid (rRNA) gene sequencing as M. aloeverae. A 59-year-old woman visited the emergency room due to abdominal pain. She was hospitalized with CAPD peritonitis. The patient initially responded to empirical antibiotic treatment comprising intraperitoneal cefazolin (15 mg/kg/day) and ceftazidime (1 g/day); however, the leukocyte count of dialysate effluent increased again. M. luteus was isolated four times from peritoneal dialysate cultures. We treated the patient with intraperitoneal administration of vancomycin (2 g loading, followed by 1 g every 7 days) but needed to switch from CAPD to temporary hemodialysis. We analyzed the 16S rRNA sequence to confirm the exact causative organism, and the results revealed that the organism was M. aloeverae. Because M. aloeverae and M. luteus have sequence similarity, 16S rRNA sequencing is a useful method to distingush them.

Therapeutic efficacy of zingerone against vancomycin-induced oxidative stress, inflammation, apoptosis and aquaporin 1 permeability in rat kidney.

Vancomycin (VCM) is a glycopeptidic broad-spectrum antibiotic against methicillin-resistant Staphylococcus aureus, though it has some adverse effects, including nephrotoxicity, that limit its usefulness. Zingerone (ZO), a component of dry ginger root, has several pharmacological activities due to its antioxidant, anti-inflammatory and antiapoptotic properties. The aim of this study was to determine the therapeutic efficacy of ZO against VCM-induced oxidative stress, inflammation, apoptosis and kidney aquaporin 1 (AQP1) levels in rats. Intraperitoneal administration of VCM (200 mg/kg body weight) for seven days increased kidney lipid peroxidation and decreased antioxidant enzyme activities, including kidney superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). VCM increased serum creatinine and urea levels and induced histopathological changes while causing a decrease in AQP1 protein level. VCM also increased the levels of the inflammatory markers nuclear factor kappa B (NF-κB), B-cell lymphoma-3(Bcl-3), interleukin-1β (IL-1β), interleukin-33 (IL-33), tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS), myeloperoxidase (MPO) and cyclooxygenase-2 (COX-2). Moreover, it activated the apoptotic pathway by increasing the expression levels of p53, Bcl-2 associated X protein (Bax), cysteine aspartate specific protease-3 (caspase-3) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), which is a marker of oxidative DNA damage. Treatment with ZO (25 and 50 mg/kg body weight) at both doses prevented nephrotoxicity by ameliorating the histopathological alterations, oxidative stress, inflammation, apoptosis, oxidative DNA damage and renal AQP1 levels. The findings of the present study suggested that ZO attenuates VCM-induced nephrotoxicity.

Vancomycin Induced Eosinophilic Peritonitis, A Case Report

Drug induced peritonitis is a rare but important complication of CAPD. Hereby, we report a case that developed eosinophilic peritonitis during intraperitoneal administration of vancomycin. With a suspicion of vancomycin-induced eosinophilic peritonitis, vancomycin was discontinued. Antihistamine started and the PD effluent two days after stopping the drug revealed a WBC count of 85/µl (10% Eosinophil, 71% Lymphocytes). Systemic signs improved dramatically in less than a week. In conclusion, drug induced peritonitis should be considered in different diagnosis of each patient on CAPD before considering administering another new antibiotic.Keywords: Vancomycin; Peritonitis; Allergy and Immunology; Child.

Use of Cefazolin for Peritonitis Treatment in Peritoneal Dialysis Patients

For over two decades, intraperitoneal administration of vancomycin and an aminoglycoside has been an accepted regimen for the empiric treatment of peritonitis in the peritoneal dialysis patient, until definite identification of the organism has been made. The recent emergence of vancomycin-resistant organisms has been of great concern in many centers. The current treatment recommendation therefore is to use cefazolin in place of vancomycin. We analyzed peritonitis data from January 1, 1996 to June 30, 1997, prior to switching over to cefazolin. Seventy-five percent (27 episodes) in 1997 as compared to 78% in 1996 were due to gram-positive organisms. Twenty-two percent (8 episodes) were due to gram- negative organisms in 1997, 21% in 1996, and 3% (1 episode) due to yeast in 1997, 3% in 1996. Staphylococcus epidermidis (SE) caused 33% of the gram-positive peritonitis episodes in 1997 as compared to 37% in 1996. Twenty-two percent of the gram-positive episodes were due to Staphylococcus aureus (SA) in 1997 and 46% in 1996. Enterococcal infections were 26% in 1997 and 1% in 1996. All of these were confined to only 1 patient. The antibiogram revealed 100% sensitivity of both SA and SE to vancomycin and 100% sensitivity of SA to cefazolin, but only 11% sensitivity of SE to cefazolin. The same patient population had a 48% sensitivity of SE to cefazolin in 1996, showing a sudden and substantial increase in resistance to SE. Even though SE is thought to be a less virulent organism, treating patients with a high probability of being infected by SE with an antibiotic showing 89% resistance is not warranted.

Initial Treatment of Dialysis Associated Peritonitis: A Controlled Trial of Vancomycin versus Cefazolin

To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) improves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic. A university operated teaching hospital, with patient treatment initiated at home. One hundred thirty-one patients trained to perform peritoneal dialysis (CAPD and CCPD) and followed at the University of Iowa Hospitals and Clinics Home Dialysis Treatment Center. Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, or cefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing. Compared to cefazolin, initial peritonitis therapy with vancomycin improved the peritonitis resolution rate [67% vs 81%; p = 0.008], reduced the incidence of hospital admissions [68% vs 48%; p = 0.001], and decreased the risk of superinfection [4% vs 0%; p = 0.039]. Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.