Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes - a case report

GND
1204517665
LSF
63333
Affiliation
Department of Nephrology, University Hospital Essen, University-Duisburg Essen, Essen, Germany
Boss, Kristina;
Affiliation
Department of Nephrology, University Hospital Essen, University-Duisburg Essen, Essen, Germany
Wiegard-Szramek, Ina;
GND
1079931155
LSF
57431
Affiliation
Institute of Medical Microbiology, University Hospital Essen, University-Duisburg Essen, Essen, Germany
Dziobaka, Jan;
GND
172197155
ORCID
0000-0003-4859-7507
LSF
16039
Affiliation
Department of Nephrology, University Hospital Essen, University-Duisburg Essen, Essen, Germany
Kribben, Andreas;
GND
136560245
ORCID
0000-0001-5549-1706
LSF
55033
Affiliation
Department of Infectious Diseases, University Hospital Essen, University-Duisburg Essen, Essen, Germany
Dolff, Sebastian
Background: Peritoneal 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 presentation: A 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.

Conclusion: 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.

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