Successful use of intraperitoneal daptomycin in the treatment of vancomycin-resistant enterococcus peritonitis

Am J Kidney Dis. 2009 Sep;54(3):538-41. doi: 10.1053/j.ajkd.2008.12.017. Epub 2009 Feb 23.

Abstract

Peritoneal dialysis-associated peritonitis from such resistant organisms as vancomycin-resistant enterococci increasingly is occurring and is challenging to treat. We describe 2 cases of vancomycin-resistant entercoccus peritonitis successfully treated with intraperitoneal daptomycin. Both patients were on automated peritoneal dialysis therapy with culture-positive vancomycin-resistant Enterococcus faecium peritonitis and were treated with 10 to 14 days of intraperitoneal daptomycin given every 4 hours through manual peritoneal dialysate exchanges. Despite the known degradation in dextrose solutions, intraperitoneal daptomycin was effective in clearing both infections. Neither patient experienced a relapse or repeated peritonitis. Additional studies of dosing and pharmacokinetics of intraperitoneal daptomycin in the treatment of patients with vancomycin-resistant enterococcus peritonitis are needed.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Daptomycin / administration & dosage*
  • Enterococcus faecium* / drug effects
  • Female
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Injections, Intraperitoneal
  • Middle Aged
  • Peritonitis / drug therapy*
  • Peritonitis / microbiology
  • Treatment Outcome
  • Vancomycin / therapeutic use
  • Vancomycin Resistance / drug effects*
  • Vancomycin Resistance / physiology

Substances

  • Vancomycin
  • Daptomycin