[Peritonitis due to glycopeptides-resistant Staphylococcus epidermidis].

A 71 years old male patient with a history of hypertension for more than 20 years, with chronic kidney failure under intra-peritoneal (IP) dialysis since June 2004, presents in March 2008 with glycopeptides-resistant Staphylococcus epidermidis peritonitis. Under vancomycin IP (alone or in association), clinical symptoms do not entirely subside and bacteria as well as white blood cells do persist in the peritoneal dialysis fluid. Under rifampicin IP, all clinical and laboratory abnormalities disappear. All 4 isolates of S. epidermidis obtained in the laboratory during this infectious episode appear to be susceptible to glycopeptides by the disk diffusion method, but MICs measurements confirm resistance. The only (blood) concentration of vancomycin measured during this episode does neither allow us to affirm, nor to exclude, that sub-inhibitory concentrations of vancomycin facilitated resistance to glycopeptides. This case-report raises the question of the optimal follow-up of those patients with residual kidney function: when, how often, and how do we need to measure blood vancomycin?