title: Expanded-spectrum beta-lactamase producing Klebsiella pneumoniae-related peritonitis in a patient on peritoneal dialysis.
abstract: While hospitalized for pneumonia with ventilator-dependent respiratory failure, a 45-year-old man on continuous ambulatory peritoneal dialysis (CAPD) had nosocomial peritonitis secondary to infection by expanded spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-Kp). He was treated successfully with a 3-week course of intraperitoneal (IP) flomoxef therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy. The International Consensus Panel recommends IP ceftazidime as the treatment of choice for CAPD patients suffering Klebsiella species-related peritonitis. However, the most appropriate form of IP antibiotic therapy and the outcomes for expanded-spectrum beta-lactamase (ESBL)-producing bacteria-related peritonitis for CAPD patients have not been established yet. Further, the ability to correctly report minimal inhibitory concentrations (MICs) of ceftazidime for ESBL bacteria in the resistant range varies between laboratories, making the diagnosis of ESBL-Kp-related CAPD peritonitis more complex and difficult. Thus, it appears reasonable to suggest that its incidence is probably underestimated and its significance ignored. The authors suggest that a 3-week IP treatment with flomoxef, a synthesized oxacephem, with loading and maintenance doses of 250 and 125 mg/L, respectively, is effective and safe for ESBL-Kp-related peritonitis in these patients. ESBL producing bacterial infection should be considered as a possible cause of overt CAPD-related peritonitis. Early detection of ESBLB pathogens and institution of effective antibiotic treatment may improve the prognosis.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Niao Sung Hsiang, Kaohsiung, Taiwan.
authors.forename: Chih-Chao
authors.initials: CC
authors.lastname: Yang
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Chuang
authors.forename: Kuo-Tai
authors.initials: KT
authors.lastname: Hsu
authors.forename: Jin-Bor
authors.initials: JB
authors.lastname: Chen
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Lee
authors.forename: Chie-Te
authors.initials: CT
authors.lastname: Lee
authors.forename: Yu-Shu
authors.initials: YS
authors.lastname: Chien
authors.forename: Te-Chuan
authors.initials: TC
authors.lastname: Chen
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
mesh_terms: D001426:Bacterial Proteins / Q000096:biosynthesis; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000201:enzymology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods*; D010538:Peritonitis / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases