Medical resolution of refractory peritoneal dialysis-associated peritonitis without catheter removal.
Mabel Tan, Saradha Anantharaman, Yiting Ong et al.
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Case in brief
A man in his 60s with Escherichia coli peritoneal dialysis-associated peritonitis presented with a high effluent leucocyte count that met criteria for refractory peritonitis. The patient declined catheter removal due to high procedural risks. Continued treatment with intravenous ceftriaxone and added intraperitoneal amikacin led to a resolution of peritonitis by day 15, allowing for catheter preservation and eventual discharge.
Diagnostic / clinical pearl
Trends in effluent leucocyte counts may provide more clinical insight than strict thresholds for catheter removal in patients with refractory peritonitis.
Why it matters
This case suggests that combined intravenous and intraperitoneal antibiotic therapy may be beneficial in managing selected gram-negative infections in frail patients.