Rhodococcus equi in CAPD-associated peritonitis treated with azithromycin

Hoque, Selina; Weir, Alva; Fluck, Richard C.; Cunningham, John A.

doi:10.1093/oxfordjournals.ndt.a027166

Cited by 11 publications

(6 citation statements)

References 15 publications

(14 reference statements)

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“…Two patients had dialysate drug levels still detectable at 80 hours (0.021 mg/mL and 0.023 mg/mL), although, by this stage, the corresponding plasma levels had fallen markedly (0.035 mg/mL and 0.026 mg/mL). This information contrasts with a report of the successful use of azithromycin to treat a case of CAPD peritonitis due to Rhodococcus equi (18), an aerobic gram-positive coccobacillus (19) that acts as an intracellular organism multiplying in the phagosomes of macrophages and eventually destroying them (20). Azithromycin is a suitable choice when treating a systemic R. equi infection due to its gram-positive activity and the high intracellular concentrations it achieves.…”

Section: Discussioncontrasting

confidence: 62%

Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD

2001

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Background Azithromycin is an azalide antibiotic with a similar antibacterial spectrum to erythromycin but with greater gram-negative activity. Azithromycin displays a favorable pharmacokinetic profile, with improved absorption and higher sustained tissue concentrations compared with erythromycin. This results in a prolonged elimination half-life, suggesting a potential for treating continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Objective This study aimed to define the potential role of azithromycin in treating CAPD peritonitis. Design The pharmacokinetics and peritoneal dialysis (PD) clearance of azithromycin were studied following a single 500-mg oral dose of azithromycin. Blood and dialysate samples were taken over a 10-day period and assayed using high-pressure liquid chromatography. Setting The study took place within the Renal Unit at Southend Hospital NHS Trust, a district general hospital in the United Kingdom. Patients Eight patients with oliguric end-stage renal failure without peritonitis maintained on CAPD (3 x 2 L/day). Results Peak plasma concentrations occurred at 2 -3 hours with 0.35 - 1.35 mg/mL (mean 0.75). The mean elimination half-life was 84.55 hrs, and plasma clearance was 21.93 L/hour. This compares with values of greater than 40 hours and 40.8 L/hour reported in healthy volunteers. After 8 hours, the mean dialysate concentration was 0.07 mg/mL; PD clearance was 0.06 L/hr. Conclusion Azithromycin is not substantially removed by CAPD in the absence of peritonitis and cannot be recommended for widespread use in this setting at present. However, the successful use of azithromycin in CAPD peritonitis, due possibly to an intracellular drug transport mechanism, has been reported. Future research should address this possibility.

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Section: Discussioncontrasting

confidence: 62%

Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD

2001

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“…were reported, 10 with Rhodococcus equi and one with Rhodococcus erythropolis. None followed direct contact with animals although in one, the patient owned a dog with which he walked regularly along a bridle path used by horseriders (49). A 2003 review of the published cases emphasizes the diagnostic challenge that rhodococcal infections present.…”

Section: Infectious Organisms Shared By Animals and Humansmentioning

confidence: 99%

Pets-Related Peritonitis in Peritoneal Dialysis: Companion Animals or Trojan Horses?

Broughton

Verger

Goffin

2010

Seminars in Dialysis

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Infectious peritonitis is still a major concern in peritoneal dialysis (PD). Standard antibiotic regimens target common causative microorganisms such as Staphylococcus aureus and epidermidis or Pseudomonas aeruginosa. When the infection does not respond, unusual infective agents are to be considered including zoonoses-infections with an animal source. Companion animals or occupations involving animal contact favor the development of zoonoses, especially for immunocompromised patients such as those with end-stage renal disease. We reviewed the literature for all animals-related peritonitis in PD and analyzed data from our own PD unit and from the French-speaking registry for peritoneal dialyis (RDPLF) to assess both the frequency and the potential risk for PD patients in owning a pet or to working with animals. In a literature search, we identified 124 cases of PD peritonitis caused by 12 different zoonotic agents. Animals were involved in 24% of the cases. Overall mortality rate was 13.5% and Tenckhoff catheters had to be removed in 27% of the cases. The results from RDPLF analysis show that zoonotic microorganisms were responsible for 0.54% of the peritonitis episodes (51 out of a total of 9433 during a 9-year period). In our unit, zoonotic microorganisms were responsible for 0.03% of the peritonitis episodes (four out of a total of 128 during a 9-year period). Considering those results, some specific treatment recommendations can be made, but the major factor still remains prevention, by insisting on strict hygenic measures when a PD patient owns a pet.

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“…At that time, the removal of the catheter was considered, and a review of the literature on pulmonary infections triggered a change in antimicrobial scheme with intraperitoneal vancomycin as follows for 10 days oral azithromycin was added for 3 weeks. The patient has been responding favorably to this treatment for 16 weeks [15].…”

Section: Discussionmentioning

confidence: 94%

Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Colombia

et al. 2017

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Background: In the present report case, we show a peritonitis infection in a continuous ambulatory peritoneal dialysis (CAPD) patient in Colombia. We isolated Rhodococcus equi in the peritoneal fluid culture. Rhodococcus equi is a rare pathogen in immunocompetent people. Rhodococcal peritonitis complicating CAPD has only been reported in few cases, and experience in its treatment is limited. Antimicrobial treatment is unsuccessful because of the virulence and resistance of the Rhodococcus equi. So, the removal of the catheter determines the clinical resolution in most of the cases. In our case, we present the resolution with a combined antibiotic therapy. Case presentation: We present the case of a 50-year-old female patient with chronic kidney disease secondary to diabetic nephropathy. The patient reported to our unit with abdominal pain 6 months after the start of the treatment with CAPD. An intraperitoneal empirical antibiotic scheme was initiated according to the guidelines of the International Society for Peritoneal Dialysis. Patient denies contact with farm animals in her daily life. After 7 days of treatment, Rhodococcus equi was found in the culture. It was decided to extrapolate antibiotic regimen based on the studies of immunocompromised patients suffering from pulmonary infections. The removal of the peritoneal dialysis catheter is decided, but the patient refuses to undertake the procedure. The patient progresses without abdominal pain, and the antibiotic treatment is changed by azithromycin 500 mg daily and performing peritoneal dialysis in CAPD mode. Conclusions: This case, like the previously published ones, highlights the limitations in the treatment of Rhodococcus equi due to the limited number of reported cases of this pathogen and the absence of standard treatment protocols leading to variable response rates. The therapeutic resolution was due to the prolonged use of antibiotic treatment and being aware of the potential increase of the morbidity.

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Rhodococcus equi in CAPD-associated peritonitis treated with azithromycin

Cited by 11 publications

References 15 publications

Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD

Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD

Pets-Related Peritonitis in Peritoneal Dialysis: Companion Animals or Trojan Horses?

Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Colombia

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