Patient completed treatment of cefepime and Vancomycin for a no growth peritonitis. Cultures that were repeated one week after completion and again three weeks are growing sphingomonas paucimobilis however the patient does not currently have an active peritonitis. Cell count of pd fluid is negative. Could this possibly be a biofilm on the catheter and if so any suggestions on treatment? The patient has refused catheter removal and temporary hemodialysis. Thank You

Questions About PD

Laura V, Nurse from Ohio asked
Patient completed treatment of cefepime and Vancomycin for a no growth peritonitis. Cultures that were repeated one week after completion and again three weeks are growing sphingomonas paucimobilis however the patient does not currently have an active peritonitis. Cell count of pd fluid is negative. Could this possibly be a biofilm on the catheter and if so any suggestions on treatment? The patient has refused catheter removal and temporary hemodialysis. Thank You

1 answer

Johann Morelle, MD, Europe January 28, 2019

It is indeed likely there is a biofilm on the catheter. Except from catheter removal, there are currently no high-level evidence about the optimal treatment for such situation.
For refractory or relapsing cases of coagulase-negative staphylococcus PD-associated peritonitis, we use a protocol combining intraperitoneal instillation of urokinase and antibiotherapy, which increases the rate of catheter salvage (Demoulin et al, Perit Dial Int 2009). 
Our experience with such organisms is more limited but we would consider this protocol as a reasonable alternative, provided antibiotics are adapted, the patient has no contraindication to urokinase, and he is well-informed the procedure constitutes an alternative to existing guidelines but is not based on large clinical trials (because of his request not to remove the peritoneal catheter).

#1

Please login to submit an answer