Use of a Novel Antibiotic (Tigecycline) in the Treatment of Peritoneal Dialysis‐Associated MRSA Peritonitis
Year: 2008
Type: article
Study design: Case Report
Abstract: Antimicrobial resistance has been recognized as a major public health concern in the United States and worldwide. The increased use and misuse of antimicrobial agents has led to the development of resistant bacterial strains, which are difficult to treat. These infections often require the use of more potent and novel antimicrobials. Resistant gram-positive infections such as methicillin-resistant Staphylococcus aureus (MRSA) are leading causes of serious nosocomial and, more recently, communityacquired infections.1 Peritoneal dialysis (PD)-associated MRSA infections are not a common cause of infection, but when they do occur, they often require removal of the catheter and treatment with vancomycin and other antibiotics. We present a case of PD-associated MRSA peritonitis that was successfully treated with tigecycline, a novel antibiotic. A 28-year-old woman with a history of chronic renal failure receiving peritoneal dialysis was scheduled to have a livingrelated transplant on the day of admission. However, the day she was admitted she developed a fever ranging between 100°F and 102°F that was associated with abdominal pain that worsened over the next several hours. Pertinent physical findings included blood pressure of 110/90 mm Hg, pulse rate of 110/min, temperature of 102°F, and diffuse abdominal pain with guarding and no rebound tenderness. The patient was given 1 mg of vancomycin intravenously and then started on ceftriaxone and metronidazole. Laboratory results showed the PD fluid contained 4760 WBC/mm3, with 91% polymorph nuclear leukocytes, and 40 RBCs/mm3. Her BUN and creatine were 33 and 12.8 mg/dL, respectively. Her white blood cell count was 4.2/mm3, and her platelets were 133,000/mm3. The results of liver function tests were normal. PD fluid cultures revealed a pure growth of MRSA. The patient was started on tigecycline (100 mg loading and 50 mg intravenously every 12 hours) for a total of 14 days. Repeat PD fluid analysis showed a decreased WBC count with resolution of the clinical symptoms of peritonitis. After treatment, she was followed for 8 weeks without evidence of recurrence. She is going to have the renal transplant surgery sometime in the next 3 months. Tigecycline, the first of a new synthetic class of antibiotics known as glycylcyclines, was approved in 2005.2 Tigecycline is a broad-spectrum antibiotic with activity against gram-positive, gram-negative, and atypical anaerobes.3 Tigecycline has been studied in the treatment of complicated skin infections and skin structure infections, intra-abdominal infections, and pneumonia.4 At present, data on the effectiveness of this drug for MRSA peritonitis is limited. To our knowledge, only a couple of clinical trials that included only a few patients with MRSA have evaluated the effectiveness of tigecycline in treating peritonitis. Babinchak et al. evaluated the safety and effectiveness of tigecycline in patients with complicated intra-abdominal infections.5 Bacterial eradication was achieved for 75% of patients with intra-abdominal MRSA (3 of 4 patients) compared with 33% for imipenen-cilastatin. In the same study, with tigecycline treatment, the cure rate of the 18 patients diagnosed with peritonitis was 88.9%. In a second trial, Oliva et al. reported a 89.8% clinical cure rate for monomicrobial infections and a 75.3% clinical cure rate for polymicrobial infections.6 Similar rates were reported for imipenem/cilastatin. However, because of the small number of resistant isolates (Enterococcus faecalis, MRSA, ESBL-producing Enterobacter) in this trial, the effectiveness of tigecycline was not conclusively established. The present case illustrates several interesting points: First, MRSA peritonitis is not a common presentation, but when it does occur, it can be associated with PD catheter infections. Second, removal of the PD device is necessary to treat this condition. Third, in addition to other drugs with gram-positive coverage, tigecycline may also prove to be an effective drug for the treatment of MRSA peritonitis, although more clinical data are required.
Source: Dialysis & Transplantation
DOI: 10.1002/dat.20156
Authors: S. Antony, D. C. Dominguez
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2070511175