Journal List > Kosin Med J > v.28(1) > 1057008

Jeong, Ham, Jo, Sin, Heo, and Rim: Extended Spectrum β-lactamase–producing E. coli-related Nosocomial Peritonitis Treated Successfully with Meropenem in a Patient on Peritoneal Dialysis


Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL–producing E. coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.


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Fig. 1.
The clinical evolution of hospital course (x axis is admission date. y axis is dialysate WBC count).
Table 1.
Sensitivity pattern for extended spectrum β-lactamase Escherichia coli strain
Sensitivities Antibiotic MIC (μg/mL)
Sensitive Imipenem < 1
Meropenem < 0.25
Intermediate Amoxicillin 16
Persistant Piperacillin > 1.28
Ampicillin > 32
Cefoxitin > 64
Cefotaxime > 64
Ceftazidime > 4
Cefefime > 8
Aztreonam > 16
Levofloxacin > 8

ESBL, extended spectrum β-lactamase; MIC, minimum inhibitory contraction

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