PDI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Perit Dial Int 29(5): 548-553
2009
© 2009 International Society for Peritoneal Dialysis
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Demoulin, N.
Right arrow Articles by Goffin, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Demoulin, N.
Right arrow Articles by Goffin, E.

Clinical Sciences

INTRAPERITONEAL UROKINASE AND ORAL RIFAMPICIN FOR PERSISTING ASYMPTOMATIC DIALYSATE INFECTION FOLLOWING ACUTE COAGULASE-NEGATIVE STAPHYLOCOCCUS PERITONITIS

Nathalie Demoulin and Eric Goffin

Service de Néphrologie, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium

Correspondence to: E. Goffin, Service de Néphrologie, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium. goffin{at}nefr.ucl.ac.be

{diamondsuit} Background: Coagulase-negative staphylococcus (CoNS) is responsible for cases of refractory and relapsing peritonitis in peritoneal dialysis (PD) patients, probably by biofilm formation on the catheter. The ISPD recommends catheter removal in such cases. Urokinase has been used to dissolve the biofilm lining the PD catheter, thus favoring antibiotic efficacy. Rifampicin has shown its efficacy in penetrating CoNS biofilm.

{diamondsuit} Methods: We defined persisting asymptomatic CoNS dialysate infection as a peritonitis episode with clinical improvement within 48 hours and dialysate clearing, but with persisting positive dialysate cultures. We retrospectively analyzed the outcome of such cases observed between 1/1998 and 12/2007. In all cases, intraperitoneal (IP) urokinase (100 000 units) and oral rifampicin (600 mg every day for 3 weeks) were added to intravenous vancomycin.

{diamondsuit} Results: 33 cases of CoNS peritonitis were recorded and 11 of them (33.3%) met the criteria of persisting asymptomatic CoNS dialysate infection. All were initially treated with intravenous vancomycin and oral ciprofloxacin, according to our protocol. Dialysate clearing, defined by a white blood cell count <100/µL, was noted at day 8 (range 4 – 17 days) on average, while dialysate cultures were still positive a mean of 6 (range 0 – 16) days later [i.e., 13.9 (range 5 – 24) days after peritonitis onset]. IP urokinase instillation was performed an average of 18.9 (range 11 – 30) days after peritonitis onset. Treatment success, defined by peritonitis resolution with sterilization of the dialysate, without catheter removal and relapse peritonitis within 6 weeks of treatment completion, was observed in 7 of 11 (64%) cases. No side effects following IP urokinase instillation were noted. One case of rifampicin-induced toxidermia was recorded.

{diamondsuit} Conclusion: IP urokinase and oral rifampicin in addition to conventional antibiotics resulted in a catheter salvage rate of 64% in persisting asymptomatic dialysate infection following a CoNS peritonitis. Larger studies are needed to confirm these results. In CoNS peritonitis, dialysate cultures should be repeated, even after clearing of the dialysate, to avoid missing persisting asymptomatic infection.

KEY WORDS: Coagulase-negative staphylococcus; peritonitis; urokinase; rifampicin; biofilm.

Received 11 March 2008; accepted 11 November 2008.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Multimed Inc. logo
Copyright © 2009 by Multimed Inc.