Department of Internal Medicine, Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan, ROC.
Blood Purif. 2011;32(4):249-52. doi: 10.1159/000328028. Epub 2011 Aug 12.
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.
腹膜透析患者由于皮肤屏障功能受损、腹膜导管存在和免疫系统功能缺陷，易发生革兰氏阳性菌感染。特别是耐甲氧西林金黄色葡萄球菌（MRSA）感染的治疗具有临床挑战性。本文报道了 1 例 MRSA 腹膜炎患者，其经 14 天腹腔内万古霉素治疗无效。为克服对万古霉素的不敏感性，我们将方案转换为腹腔内达托霉素（每 6 小时通过手动腹膜透析液交换给予）和口服利福平（每日 2 次，每次 300mg）。腹膜炎消退，无后遗症或复发。我们建议达托霉素和利福平作为治疗 MRSA 感染的替代联合治疗方案，否则感染可能无法解决。
