title: Successful salvage of peritoneal catheter in unresolved methicillin-resistant staphylococcus aureus peritonitis by combination treatment with daptomycin and rifampin.
abstract: Peritoneal dialysis patients are at an increased risk of Gram-positive organism infections because of disrupted skin barrier function, presence of a peritoneal catheter, and a deficient immunological system. In particular, the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections is clinically challenging. Herein, we present a case of MRSA peritonitis that showed no response to a 14-day treatment with intraperitoneal vancomycin. To overcome unresponsiveness to vancomycin, we shifted the regimen to intraperitoneal daptomycin (given every 6 h through manual peritoneal dialysate exchanges) and oral rifampin (300 mg twice daily). The peritonitis resolved without sequelae or relapse. We suggest daptomycin and rifampin as an alternative combination therapy for MRSA infections that may otherwise remain unresolved.
authors.affiliation: Department of Internal Medicine, Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.forename: Mao-Wang
authors.initials: MW
authors.lastname: Ho
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: Yao-Long
authors.initials: YL
authors.lastname: Liu
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Tsung-Lin
authors.initials: TL
authors.lastname: Hsieh
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D017576:Daptomycin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D010529:Peritoneal Cavity; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012293:Rifampin / Q000627:therapeutic use*; D016879:Salvage Therapy; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin; D012293:Rifampin