Srithongkul Thatsaphan, Raksasuk Sukit, Techajongnumchai Bulaporn, Sritippayawan Suchai, Koomanachai Pornpan
Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2025 Jan 6;20(1):e0312160. doi: 10.1371/journal.pone.0312160. eCollection 2025.
A single dose of intraperitoneal (IP) meropenem is recommended for peritoneal-dialysis (PD)-related peritonitis stemming from extended-spectrum β-lactamase-producing organisms. However, data on IP meropenem is limited.
This prospective, descriptive study was conducted to examine plasma and dialysate meropenem levels during continuous IP meropenem administration in five patients with PD-related peritonitis. All patients received an IP meropenem loading dose of 500 mg, followed by IP meropenem at 125 mg/L, with four exchanges daily. The plasma and dialysate meropenem concentrations were measured at specified intervals for a 24-hour period utilizing a high-performance, liquid chromatography method.
Five patients with PD related peritonitis were studied. The mean-maximum dialysate and plasma meropenem levels were 158.1 mg/L (standard deviation [SD] ± 62.9) and 29.4 mg/L (SD ± 15.9), respectively. The mean dialysate meropenem level was at its minimum of 32.6 mg/L (SD ± 19.1) at 24 hours. Throughout the period, the dialysate meropenem levels exceeded the minimal inhibitory concentration of the pathogenic resistance organism (> 8 mg/L). Four patients responded to the treatment, whereas one developed treatment failure from fungal peritonitis.
An IP meropenem loading of 500 mg, followed by 125 mg/L every 6 hours, provided an adequate dialysate meropenem concentration and is an effective treatment for PD related peritonitis.
Thai Clinical Trials Registry (TCTR20191121002) with date of first registration at 21/11/2019 (retrospectively registered).
对于由产超广谱β-内酰胺酶的生物体引起的腹膜透析（PD）相关腹膜炎，推荐单次腹腔内（IP）注射美罗培南。然而，关于IP美罗培南的数据有限。
本前瞻性描述性研究旨在检测5例PD相关腹膜炎患者持续IP注射美罗培南期间血浆和美罗培南透析液水平。所有患者接受500mg的IP美罗培南负荷剂量，随后以125mg/L的IP美罗培南，每天进行4次换液。在24小时内的特定时间间隔，使用高效液相色谱法测量血浆和美罗培南透析液浓度。
研究了5例PD相关腹膜炎患者。美罗培南透析液和血浆的平均最高水平分别为158.1mg/L（标准差[SD]±62.9）和29.4mg/L（SD±15.9）。美罗培南透析液平均水平在24小时时最低，为32.6mg/L（SD±19.1）。在整个期间，美罗培南透析液水平超过了致病耐药生物体的最低抑菌浓度（>8mg/L）。4例患者对治疗有反应，而1例因真菌性腹膜炎治疗失败。
500mg的IP美罗培南负荷剂量，随后每6小时125mg/L，可提供足够的美罗培南透析液浓度，是治疗PD相关腹膜炎的有效方法。
泰国临床试验注册中心（TCTR20191121002），首次注册日期为2019年11月21日（追溯注册）。
