title: Successful use of intraperitoneal daptomycin in the treatment of vancomycin-resistant enterococcus peritonitis.
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.
authors.affiliation: Section of Nephrology, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Huen
authors.forename: Isaac
authors.initials: I
authors.lastname: Hall
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Topal
authors.forename: Rex L
authors.initials: RL
authors.lastname: Mahnensmith
authors.forename: Ursula C
authors.initials: UC
authors.lastname: Brewster
authors.forename: Ali K
authors.initials: AK
authors.lastname: Abu-Alfa
mesh_terms: D000328:Adult; D017576:Daptomycin / Q000008:administration & dosage*; D016984:Enterococcus faecium / Q000187:drug effects; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000187:drug effects* / Q000502:physiology
chemical_list: D014640:Vancomycin; D017576:Daptomycin