Successful Treatment of Vancomycin-Resistant Enterococcus Peritonitis Using Linezolid Without Catheter Removal in a Peritoneal Dialysis Patient

Song, In Ji; Seo, Ji Won; Kwon, Young Eun; Kim, Young Ly; Lim, Tae-Young; Kang, Ea Wha; Chang, Tae Ik

doi:10.3747/pdi.2013.00076

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…This is at variance with our findings showing poor LZD tolerability in a PD patient starting treatment at 600 mg bid. This discrepancy may be only apparent considering that (a) in the previously reported case series [7], the duration of LZD therapy ranged from less than 14 days up to 3 weeks, whereas our patient experienced severe haematological toxicity after 4 weeks of LZD treatment and (b) wide inter-patient variability in the LZD exposure has been documented in patients treated with the conventional LZD doses [5]. Hence, it can be hypothesised that LZD haematological toxicity may be more frequent in patients treated for long periods.…”

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confidence: 57%

“…However, no specific indications on LZD dose adjustments in patients with renal insufficiency or with renal replacement therapy are actually given in the drug label sheet. Indeed, an optimal safety and efficacy outcome was recently reported in PD patients given LZD (either per os or intravenously) at the dose of 600 mg bid for the treatment of vancomycin-resistant infective peritonitis [7]. This is at variance with our findings showing poor LZD tolerability in a PD patient starting treatment at 600 mg bid.…”

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confidence: 44%

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Linezolid-related haematological toxicity in a peritoneal dialysis patient: the role of therapeutic drug monitoring

Gervasoni

Terzi

Heidempergher

et al. 2015

Eur J Clin Pharmacol

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Sir, Emerging evidence shows that patients with renal dysfunction or on haemodialysis treated with the conventional linezolid (LZD) dose (600 mg bid) have higher drug exposure and higher frequency of haematological toxicity compared with patients with normal renal function [1][2][3][4]. We here report the successful application of therapeutic drug monitoring (TDM) of LZD in a peritoneal dialysis (PD) patient who experienced drug-related severe thrombocytopoenia while treated with the conventional 600 mg bid LZD dose.A 66-year-old Caucasian man was admitted to the Nephrology Unit of our hospital on January 17, 2014 with a diagnosis of lumbar spondylodiscitis accompanied by iliopsoas abscesses. Magnetic resonance imaging (MRI) with gadolinium contrast (T2-weighted) performed a few days due to leg weakness and lower back pain persisting from about 1 month demonstrated vertebral osteomyelitis at the third and fourth lumbar vertebrae with intervening discitis and multiple abscesses in the iliopsoas. He had a history of type 2 diabetes mellitus, chronic renal insufficiency handled by automated PD in continuous cycled with Tidal (CCPD-17 l/die) since October 2012, and a high frequency of previous hospital admissions for septic complications. He received immediately empiric antibiotic therapy with intravenous vancomycin and gentamicin. Gentamicin was subsequently withdrawn after the blood culture performed at admission evidenced the presence of multiresistant Staphylococcus epidermidis infection. At discharge, vancomycin was replaced by oral LZD 600 mg bid (February 28, day 0). The patient was not given other concomitant drugs associated with haematologic toxicity (he was on maintenance therapy with doxazosin, epoetin beta, pantoprazole, allopurinol, calcitriol, atenolol, simvastatin and ezetimibe). As shown in Fig. 1, the patient experienced a progressive reduction in the blood platelet count, that reached a nadir of 53×10^3 cells/mL at day 30 after starting LZD treatment. A blood sample for TDM of LZD trough level drawn on day 23 retrieved a LZD concentration of 25.5 mg/ L (in our centre we considered as therapeutic range a concentration window of 2-10 mg/L [5]). After the result of the LZD assessment, the drug dose was reduced from 600 to 300 mg bid. An additional LZD trough concentration of 16.0 mg/L was measured the day after drug dose adjustment, just before the administration of the morning dose. On day 29, the patient was admitted to the emergency department due to severe episodes of epistaxis that were followed by a severe reduction in the haemoglobin levels (Fig. 1). With the reduced dose of

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confidence: 57%

contrasting

confidence: 44%

Linezolid-related haematological toxicity in a peritoneal dialysis patient: the role of therapeutic drug monitoring

Gervasoni

Terzi

Heidempergher

et al. 2015

Eur J Clin Pharmacol

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“…According to the International Society for Peritoneal Dialysis (ISPD), IP application of ampicillin is the therapy of choice for susceptible enterococci. For resistant strains, vancomycin, linezolid, or daptomycin are recommended [2,[10][11][12]. However, little data are available on a possible interference between peritoneal dialysis fluids (PDFs) and the activity of antimicrobial agents.…”

Section: Introductionmentioning

confidence: 99%

The influence of different peritoneal dialysis fluids on the in vitro activity of ampicillin, daptomycin, and linezolid against Enterococcus faecalis

Kussmann

Schuster

Zeitlinger

et al. 2015

Eur J Clin Microbiol Infect Dis

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Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis-related peritonitis. However, little data are available on a possible interference between peritoneal dialysis fluids and the activity of antimicrobial agents. Thus, the present in vitro study set out to investigate the influence of different peritoneal dialysis fluids on the antimicrobial activity of ampicillin, linezolid, and daptomycin against Enterococcus faecalis. Time-kill curves in four different peritoneal dialysis fluids were performed over 24 h with four different concentrations (1 × MIC, 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated. Cation-adjusted Mueller-Hinton broth was used as the comparator solution. All four peritoneal dialysis fluids evaluated had a bacteriostatic effect on the growth of Enterococcus faecalis. Compared to the cation-adjusted Mueller-Hinton broth comparator solution, the antimicrobial activity of all antibiotics tested was reduced. For ampicillin and linezolid, no activity was found in any peritoneal dialysis fluid, regardless of the concentration. Daptomycin demonstrated dose-dependent activity in all peritoneal dialysis fluids. Bactericidal activity was observed at the highest concentrations evaluated in Dianeal® PDG4 and Extraneal®, but not in concentrations lower than 30 × MIC and not in Nutrineal® PD4 and Physioneal® 40. The antimicrobial activity of ampicillin and linezolid is limited in peritoneal dialysis fluids in vitro. Daptomycin is highly effective in peritoneal dialysis fluids and might, thus, serve as an important treatment option in peritoneal dialysis-related peritonitis. Further studies are needed to evaluate the clinical impact of the present findings.

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“…The Gram stain of exit-site drainage may help to guide the subsequent antibiotic therapy. Dosing recommendations for frequently used oral antibiotics are shown in Table 4 (86,144,145,165,(182)(183)(184)(185)(186)(187)(188)(189)(190)(191)(192)(193)(194)(195). The presence of granulation tissue over the exit site without other features of infection does not require antibiotic treatment.…”

Section: Empirical Antibiotic Treatmentmentioning

confidence: 99%

ISPD Catheter-Related Infection Recommendations: 2017 Update

et al. 2017

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Successful Treatment of Vancomycin-Resistant Enterococcus Peritonitis Using Linezolid Without Catheter Removal in a Peritoneal Dialysis Patient

Cited by 14 publications

References 13 publications

Linezolid-related haematological toxicity in a peritoneal dialysis patient: the role of therapeutic drug monitoring

Linezolid-related haematological toxicity in a peritoneal dialysis patient: the role of therapeutic drug monitoring

The influence of different peritoneal dialysis fluids on the in vitro activity of ampicillin, daptomycin, and linezolid against Enterococcus faecalis

ISPD Catheter-Related Infection Recommendations: 2017 Update

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