rifampin and Peritonitis

Isolated case reports of peritonitis due to Brucella spp. during peritoneal dialysis (PD) continue to surface in the medical literature. However, the optimal treatment regimen for these patients, in particular with regards to the fate of PD catheter, is still largely unknown. We report a case of brucella peritonitis successfully treated with intraperitoneal administration of amikacin, along with oral rifampicin and doxycycline but without catheter removal. Furthermore, we have reviewed the literature up until present day.

Topics: Administration, Oral; Amikacin; Anti-Bacterial Agents; Brucellosis; Catheter-Related Infections; Doxycycline; Follow-Up Studies; Humans; Injections, Intraperitoneal; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Rifampin; Treatment Outcome

The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71 % white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin (P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study (P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.16/yr (P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.12/yr (P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Catheters, Indwelling; Chemoprevention; Diabetes Mellitus, Type 1; Drug Administration Schedule; Equipment Contamination; Equipment Failure; Female; Follow-Up Studies; Humans; Male; Mupirocin; Nose; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Staphylococcal infections are a major cause of catheter infections and peritonitis in peritoneal dialysis patients. Since catheter-related infections are associated with nasal carriage of Staphylococcus aureus in this population, we studied the effect of intermittent rifampin, an antibiotic known to decrease S aureus nasal carriage, on catheter-related infections and peritonitis. We randomly assigned 64 patients to receive either rifampin 300 mg twice daily for 5 days every 3 months or no treatment. The rifampin-treated patients had a significant delay in time to first catheter-related infection (P less than 0.015) and significantly fewer catheter-related infections overall (P less than 0.001). The catheter-related infection rate in rifampin-treated patients was .26 per patient-year versus .93 per patient-year in untreated patients. Multivariate analysis defined baseline colonization of nares or catheter exit-site and prior renal transplant as risk factors for catheter-related infections. There was no significant difference in peritonitis rates between groups, although the trend was for a delayed time to first episodes and fewer episodes in rifampin-treated patients. Adverse effects necessitated withdrawal of rifampin in four patients. We conclude that intermittent rifampin administration is effective in decreasing catheter-related infections in a peritoneal dialysis population.

Topics: Adult; Bacteriological Techniques; Catheters, Indwelling; Data Interpretation, Statistical; Female; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Staphylococcal Infections; Staphylococcus aureus

A randomized prospective study was undertaken in patients on continuous ambulatory peritoneal dialysis (CAPD) to evaluate the efficacy of three different antibiotic regimens for the treatment of peritonitis. There were 39 episodes in each treatment group. Patients were treated with intraperitoneal (IP) cephalothin (250 mg/L) and tobramycin (8 mg/L) in group 1, oral ofloxacin (400 mg loading followed by 300 mg daily) in group 2, and a combination of ofloxacin (400 mg followed by 300 mg daily) and rifampicin (300 mg daily). Treatment duration was 10 days. The average culture-positive rate was 75%. The overall cure rate was 80.6% with IP antibiotics, 78.4% with oral ofloxacin, and 81.1% with ofloxacin and rifampicin. After the exclusion of tunnel infections and episodes of peritonitis due to Pseudomonas and resistant organisms, the corresponding figures were 100%, 90.6%, and 93.7%, respectively. Side effects were minimal with IP treatment and with oral ofloxacin, but severe nausea and vomiting occurred in some cases with the combination of ofloxacin and rifampicin. It was concluded that oral ofloxacin is an acceptable first-line therapy for peritonitis in CAPD patients.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Bacteria; Cephalothin; Drug Therapy, Combination; Female; Humans; Injections, Intraperitoneal; Male; Middle Aged; Ofloxacin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Randomized Controlled Trials as Topic; Rifampin; Tobramycin

Topics: Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Cell Membrane; Drug Resistance, Bacterial; Drug Synergism; Erythromycin; Escherichia coli; Escherichia coli Infections; Lipopeptides; Male; Mice; Mice, Inbred ICR; Peptidomimetics; Peritonitis; Rifampin; Sepsis

Acinetobacter baumannii resistance to carbapenem antibiotics is a serious clinical challenge. As a newly developed technology, silver nanoparticles (AgNPs) show some excellent characteristics compared to older treatments, and are a candidate for combating A. baumannii infection. However, its mechanism of action remains unclear. In this study, we combined AgNPs with antibiotics to treat carbapenem-resistant A. baumannii (aba1604). Our results showed that single AgNPs completely inhibited A. baumannii growth at 2.5 μg/mL. AgNP treatment also showed synergistic effects with the antibiotics polymixin B and rifampicin, and an additive effect with tigecyline. In vivo, we found that AgNPs-antibiotic combinations led to better survival ratios in A. baumannii-infected mouse peritonitis models than that by single drug treatment. Finally, we employed different antisense RNA-targeted Escherichia coli strains to elucidate the synergistic mechanism involved in bacterial responses to AgNPs and antibiotics.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; Carbapenems; Drug Synergism; Humans; Male; Metal Nanoparticles; Mice, Inbred C57BL; Microbial Sensitivity Tests; Peritonitis; Rifampin; Silver

Brucellosis is a common zoonotic disease with worldwide distribution and protean clinical manifestations. Therefore, its prompt and timely diagnosis is still challenging. Among several complications of brucellosis, spontaneous bacterial peritonitis (SBP) in previously healthy participants is rarely recognised, although this condition can be fatal if misdiagnosed and untreated. We present a case of a 69-year-old previously healthy stockbreeder who suffered from back pain along with abdominal pain and distension because of ascites of 6-8 weeks duration. Cultures of ascitic fluid and peripheral blood specimens revealed Brucella spp as the causative agent of ascites and spondylodiscitis, which was then confirmed by MRI findings. After appropriate treatment for 4.5 months (streptomycin 1 g/day for 3 weeks intramuscularly, doxycycline 100 mg twice a day orally and rifampicin 900 mg/day orally), the patient fully recovered. Conclusively, in the appropriate epidemiological and clinical setting, the consideration of brucellosis in the differential diagnosis of SBP could be rational as well as life-saving.

Topics: Abdominal Pain; Aged; Animal Husbandry; Anti-Bacterial Agents; Ascites; Back Pain; Brucella; Brucellosis; Doxycycline; Humans; Male; Peritonitis; Rifampin; Streptomycin; Treatment Outcome

Peritonitis is an important cause of morbidity in patients undergoing peritoneal dialysis. Rothia mucilaginosa has been reported as an unusual cause of peritoneal dialysis associated peritonitis. Difficulty in the management of this microorganism lies in the absence of uniform recommendations for anti-microbial therapy directed against this pathogen. The current report describes the clinical course of an episode of peritoneal dialysis associated peritonitis caused by Rothia mucilaginosa. Treatment options for this organism are summarized.

Topics: Actinomycetales Infections; Administration, Oral; Adult; Drug Therapy, Combination; Female; Humans; Infusions, Parenteral; Micrococcaceae; Peritoneal Dialysis; Peritonitis; Rifampin; Treatment Outcome; Vancomycin

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.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Daptomycin; Drug Therapy, Combination; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Salvage Therapy; Staphylococcal Infections; Treatment Outcome

Antibiotic treatment of Staphylococcus aureus infections is often problematic due to the slow response to therapy and the high frequency of infection recurrence. The intracellular persistence of staphylococci has been recognized and could offer a good explanation for these treatment difficulties. Knowledge of the interplay between intracellular antibiotic activity and the overall outcome of infection is therefore important. Several intracellular in vitro models have been developed, but few experimental animal models have been published. The mouse peritonitis/sepsis model was used as the basic in vivo model exploring a quantitative ex vivo extra- and intracellular differentiation assay. The intracellular presence of S. aureus was documented by electron microscopy. Five antibiotics, dicloxacillin, cefuroxime, gentamicin, azithromycin, and rifampin (rifampicin), were tested in the new in vivo model; and the model was able to distinguish between their extra- and intracellular effects. The intracellular effects of the five antibiotics could be ranked as follows as the mean change in the log(10) number of CFU/ml (Delta log(10) CFU/ml) between treated and untreated mice after 4 h of treatment: dicloxacillin (3.70 Delta log(10) CFU/ml) > cefuroxime (3.56 Delta log(10) CFU/ml) > rifampin (1.86 Delta log(10) CFU/ml) > gentamicin (0.61 Delta log(10) CFU/ml) > azithromycin (0.21 Delta log(10) CFU/ml). We could also show that the important factors during testing of intracellular activity in vivo are the size, number, and frequency of doses; the time of exposure; and the timing between the start of infection and treatment. A poor correlation between the intracellular accumulation of the antibiotics and the actual intracellular effect was found. This stresses the importance of performing experimental studies, like those with the new in vivo model described here, to measure actual intracellular activity instead of making predictions based on cellular pharmacokinetic and MICs.

Topics: Animals; Animals, Outbred Strains; Anti-Bacterial Agents; Colony Count, Microbial; Dicloxacillin; Dose-Response Relationship, Drug; Female; Humans; Mice; Microbial Sensitivity Tests; Peritoneum; Peritonitis; Rifampin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Peritonitis due to brucellosis is extremely rare and the reported cases are mostly chronic hepatic failure patients with ascites or chronic renal failure patients on continuous ambulatory peritoneal dialysis. We report a 20-year-old male patient, with no underlying disease, who was diagnosed as peritonitis due to brucellosis mimicking tuberculosis, with ascites with pleocytosis, lymphocytic predominance and high levels of adenosine deaminase.

Topics: Anti-Bacterial Agents; Ascites; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Paracentesis; Peritonitis; Peritonitis, Tuberculous; Rifampin; Young Adult

An unusual case of peritonitis in a 61-year-old patient is reported where culture for bacteria and fungi were negative. Acanthamoeba was isolated and the patient was treated with Ceftazidine, Cefazolin, Levofloxacin, Fluconazole and Rifampicin with regular haemodialytic support. The patient was completely cured of the infection and continuous ambulatory peritoneal dialysis (CAPD) fluid became clear after 2 weeks of treatment. Diagnosis and treatment of Acanthamoeba infections are difficult due to the rarity of the infections, lack of familiarity of most clinicians with disease syndromes, and limitations of therapeutics options. Even an experienced microbiologist can easily mistake the amoebae in ascitic fluid for peritoneal macrophages or lymphocytes.

Topics: Acanthamoeba; Amebiasis; Drug Therapy, Combination; Fluconazole; Humans; Immunocompromised Host; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

Topics: Aged; Antitubercular Agents; Dominican Republic; Ethambutol; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Peritonitis; Rhode Island; Rifampin; Tuberculosis

Cryoglobulinemia has been described in infectious diseases, but in only three patients with brucellosis. We report a 59-year-old male with Brucella peritonitis with cutaneous vasculitis and renal failure that could be related to mixed cryoglobulinemia. As in cryoglobulinemia associated with other infections, resolution of the disease was obtained with specific antimicrobial therapy.

Topics: Anti-Bacterial Agents; Ascitic Fluid; Brucella melitensis; Brucellosis; Cryoglobulinemia; Doxycycline; Humans; Male; Middle Aged; Ofloxacin; Peritonitis; Renal Insufficiency; Rifampin; Vasculitis, Leukocytoclastic, Cutaneous

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Doxycycline; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

For the initial treatment of peritonitis complicating peritoneal dialysis (PD), we use intraperitoneally administered gentamicin (broad spectrum and low costs) and rifampin (intracellular bactericidal activity). In order to assess the efficacy of this treatment, the outcome of 248 suspected episodes of peritonitis (abdominal pain, cloudy effluent, and a leukocyte count over 100/mm3) was evaluated. Of 227 cases with a positive culture of the PD effluent, one bacterial species was cultured in 188 cases (75.8%), more than one in 32 cases (12.9%), and in 7 cases (2.8%) yeasts. In 87.2% of the culture-positive cases, a good clinical response to the initialized antibiotic therapy was found. In 20 cases (8.1%) antibiotic treatment was discontinued within one week because no micro-organisms were cultured. In one case no effluent was cultured. Although in vitro resistance or indifference to both antibiotics was found in 45 cases (19.8%), in only 29 culture-positive cases (12.8%) the clinical condition did not improve on initial therapy. Of the peritonitis episodes in which micro-organisms resistant to both antibiotics were cultured, 23 were Staphylococcus epidermidis, 5 were E. coli, 7 were yeasts, and there were miscellaneous (mostly enteral) bacteria in 10 cases. In the studied period no significant changes were found in the susceptibility of the cultured microorganisms to gentamicin and rifampin. Susceptibility profile per episode, however, showed an increasing resistance against both antibiotics. It is concluded that the combination of gentamicin and rifampin as initial treatment of peritonitis is effective in most (87%) cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Drug Therapy, Combination; Gentamicins; Humans; Microbial Sensitivity Tests; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Retrospective Studies; Rifampin

The efficacy of rifampin in eliminating Staphylococcus aureus colonization was evaluated in a pediatric peritoneal dialysis population. Six children with documented nasal colonization were treated for 7 days with rifampin and cloxacillin. Although antimicrobial therapy eliminated nasal carriage in all patients, recolonization occurred in 66%. Exit site colonization proved difficult to eradicate with negative cultures documented in only 3 of 5 children after rifampin/cloxacillin therapy. Although S. aureus carriage is a risk factor for S. aureus infections, efforts to eradicate carriage with rifampin are hindered by rapid recolonization.

Topics: Antibiotics, Antitubercular; Catheters, Indwelling; Child; Cloxacillin; Colony Count, Microbial; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Male; Nose; Penicillins; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Staphylococcus aureus

Topics: Adult; Cephalothin; Drug Therapy, Combination; Glomerulonephritis, Membranous; Humans; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperacillin; Rifampin; Streptococcal Infections; Streptococcus agalactiae

To identify factors associated with peritoneal dialysis-related infections at one center.. The study was a retrospective study of a 3-year time period with relatively stable treatment patterns.. A single center experienced academic peritoneal dialysis program.. Patients (N = 163) receiving peritoneal dialysis (PD) from January 1989 to December 1991 who had received treatment at home for at least one month.. None.. Catheter-related infection and peritonitis were the main outcome measures. Variables affecting infection rates that were assessed included age, time on PD, prior end-stage renal disease (ESRD) therapy, diabetic status, catheter type, exchange device, nasal carriage of S. aureus, and prophylactic rifampin therapy. Data were analyzed with univariate as well as with a fixed-effects and a mixed-effects gamma-Poisson multiple regression model.. Variables associated with an increased risk of new peritonitis included age under 20 years (p < 0.009; rate ratio 4.54) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.75). Decreased new peritonitis risk was associated with the ULTRA Set exchange system (p < 0.008; risk ratio 0.38) and intermittent prophylactic rifampin therapy (p < 0.001; rate ratio 0.99 for each 1% time on therapy). Catheter-related infections were increased in patients who had double-cuff catheters (p < 0.003) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.82). Decreased catheter-related infections were noted in older patients (p < 0.02; rate ratio 0.983/year) and increasing months of study follow-up (p < 0.03; rate ratio 0.97/month).. In our program nasal carriage of S. aureus increased the risk of peritonitis and catheter-related infection. Prophylactic rifampin significantly decreased peritonitis, as did use of the ULTRA Set. Single-cuff opaque catheters had the lowest catheter infection rate. Analysis of the relationships between clinical and demographic variables and peritoneal dialysis-related infection rate can identify significant contributing or protective variables and allow peritoneal dialysis programs to develop preventive strategies to minimize the risk of infection.

Topics: Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Models, Statistical; Multivariate Analysis; Nasal Mucosa; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Staphylococci are the leading pathogens in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Vancomycin appears to be an outstanding antistaphylococcal drug because resistance to it is nearly absent. The pharmacokinetics of vancomycin and clinical cure rates of peritonitis with different dosing guidelines have been studied extensively. Different dosing guidelines with IP or IV loading doses followed or not followed by IP maintenance doses are used successfully, despite the fact that some of the dosing schemes produce apparently suboptimal drug levels referring to in vitro data like the MIC value (minimum inhibitory concentration). Alternatively, aminoglycosides, cephalosporins, isoxazolyl penicillins, and broad-spectrum penicillins combined with beta-lactamase inhibitors may be used for the treatment of gram-positive peritonitis. For the above penicillins pharmacokinetic data are scarce, and clinical experience is limited. Rifampin has excellent intracellular antistaphylococcal activity and should be used in combination with other antibiotics. Although pharmacokinetic data are lacking, rifampin dosages do not require adaptation to renal function or replacement therapy.

Topics: Anti-Bacterial Agents; Humans; Penicillins; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

Topics: Adult; Animals; Ascitic Fluid; Brucella melitensis; Brucellosis; Denmark; Female; Goats; Humans; Hydrocephalus; Milk; Peritonitis; Rifampin; Tetracycline; Turkey; Ventriculoperitoneal Shunt; Yogurt

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Male; Peritonitis; Rifampin; Staphylococcal Infections

Mycobacterium kansasii was isolated from the peritoneal fluid, peritoneal biopsy, and the Tenckhoff catheter of a 62-year-old woman undergoing continuous ambulatory peritoneal dialysis (CAPD) who presented with the clinical picture of peritonitis. To the best of our knowledge, this is the first case of CAPD-associated peritonitis caused by M kansasii. Routine susceptibility tests using standard concentrations of isoniazid indicated isoniazid resistance; however, the organism was inhibited in vitro by a higher concentration of this drug. The patient responded to combination therapy with isoniazid and rifampin, as well as removal of the catheter. This report emphasizes the importance of mycobacterial cultures, in certain circumstances, in patients with CAPD-associated peritonitis and the utility of quantitative in vitro susceptibility testing.

Topics: Drug Therapy, Combination; Female; Humans; Isoniazid; Microbial Sensitivity Tests; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

Topics: Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Humans; Lactobacillus; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Vancomycin

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Drug Interactions; Drug Therapy, Combination; Humans; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin; Staphylococcal Infections

Topics: Adolescent; Female; Heroin Dependence; Humans; Injections, Intravenous; Peritonitis; Pneumonia, Staphylococcal; Rifampin; Staphylococcal Infections; Vancomycin

Topics: Adrenal Cortex Hormones; Adult; Ethambutol; Female; Humans; Isoniazid; Laparotomy; Middle Aged; Peritonitis; Peritonitis, Tuberculous; Radiography, Abdominal; Radiography, Thoracic; Rifampin; Tuberculosis, Gastrointestinal