Letter to the Editor
Daptomycin in peritoneal dialysis, intraperitoneal or intravenous
Daptomicina en diálisis peritoneal, intraperitoneal o intravenosa
Cristina Pérez Melón
, Maria Borrajo Prol, Elena Iglesias, Beatriz Ferreiro, Maria Camba Caride
Corresponding author
Servicio de Nefrología, Complejo Hospitalario Universitario de Orense, Orense, Spain
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peritoneal dialysis, intraperitoneal or intravenous" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "462" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Pérez Melón, Maria Borrajo Prol, Elena Iglesias, Beatriz Ferreiro, Maria Camba Caride" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Pérez Melón" "email" => array:1 [ 0 => "cristicpm@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Maria" "apellidos" => "Borrajo Prol" ] 2 => array:2 [ "nombre" => "Elena" "apellidos" => "Iglesias" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Ferreiro" ] 4 => array:2 [ "nombre" => "Maria" "apellidos" => "Camba Caride" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Complejo Hospitalario Universitario de Orense, Orense, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Daptomicina en diálisis peritoneal, intraperitoneal o intravenosa" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recurrent peritonitis due to a suspected biofilm causes substantial morbidity in patients with peritoneal dialysis (PD) and sometimes leads to permanent abandonment of the technique.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 55-year-old man with a prior history of meningitis due to listeria, resolved with antibiotic treatment, chronic kidney disease (CKD) secondary to membranous glomerulonephritis in PD and an adrenal incidentaloma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He visited our department owing to signs and symptoms of peritonitis due to clinically asymptomatic <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>, which resolved with intraperitoneal (IP) vancomycin administered for 14 days. The post-treatment monitoring culture was negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fifteen days after completion of antibiotic therapy, he had a recurrence of peritonitis caused by the same microorganism, and then he was treated with oral ciprofloxacin adjusted to antibiogram results without achieving a negative peritoneal fluid culture. Given the suspicion of recurring peritonitis due to a biofilm, intravenous (IV) daptomycin was started at a dose of 500<span class="elsevierStyleHsp" style=""></span>mg/48<span class="elsevierStyleHsp" style=""></span>h (residual diuresis 400<span class="elsevierStyleHsp" style=""></span>ml/24<span class="elsevierStyleHsp" style=""></span>h). After 10 days of treatment, the fluid remained slightly cloudy (220<span class="elsevierStyleHsp" style=""></span>cells/μl, 55% polymorphonuclear cells, 45% monomorphonuclear cells), with a positive culture for <span class="elsevierStyleItalic">S. epidermidis</span>. Therefore, treatment was started with IP daptomycin (200<span class="elsevierStyleHsp" style=""></span>mg loading dose followed by 40<span class="elsevierStyleHsp" style=""></span>mg in each exchange) and maintained for 14 days. Throughout this time, the patient received associated antifungal prophylaxis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The peritoneal fluid culture during and after treatment was negative.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After completing intraperitoneal antibiotic treatment, the patient resumed his usual therapy (automatic PD with a daytime exchange). He was scheduled for daptomycin lseal therapy, administered once per week for 4 weeks.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The sealing therapy protocol was performed using 35<span class="elsevierStyleHsp" style=""></span>mg of daptomycin in 7<span class="elsevierStyleHsp" style=""></span>ml of lactated Ringer's solution, with the abdomen empty for a minimum of 12<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, the patient remains asymptomatic, and has had no more episodes of peritonitis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Daptomycin is a lipopeptide antibiotic indicated in the treatment of bacteraemia, right-sided endocarditis and complicated skin infections, with anti-biofilm activity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several cases of treatment of peritonitis in PD with both IV and IP daptomycin have been reported.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Goedecke et al. showed that intravenous administration of daptomycin achieved plasma and peritoneal fluid levels greater than the minimum inhibitory concentration for microorganisms sensitive to this antibiotic. However, the study was conducted in a single patient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Subsequently, several cases were reported of peritonitis in PD that were successfully treated with IV daptomycin.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A study of the pharmacokinetics of daptomycin in PD, with the dual aim of evaluating the drug's penetration of the peritoneal cavity and obtaining a dose regimen to be administered in this type of patients that offered safety and prevented toxicity, concluded that administration at doses of 4–6<span class="elsevierStyleHsp" style=""></span>mg/kg/48<span class="elsevierStyleHsp" style=""></span>h is an appropriate regimen for treating non-peritoneal systemic infections in patients who receive continuous ambulatory PD but, owing to its limited penetration of the abdominal cavity, its administration by the IV route is not safe for the treatment of peritonitis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the case presented, daptomycin administered by the intravenous route did not achieve a negative peritoneal fluid culture. At the time of administration, peritoneal inflammation was not substantial, and the percentage of polymorphonuclear cells was only 55%, given that the patient was undergoing antibiotic treatment with ciprofloxacin, and the even lower penetration in the abdominal cavity could be attributed to this. Although there have been no studies on how peritoneal inflammation influences the concentration of daptomycin in the peritoneum, a study by Cardone et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> suggested that the peritoneal inflammation that occurs in the patients studied should to a certain extent promote the drug's penetration of the peritoneal cavity, without being able to ensure whether suitable levels would be achieved as the inflammatory process decreases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez Melón C, Borrajo Prol M, Iglesias E, Ferreiro B, Camba Caride M. Daptomicina en diálisis peritoneal, intraperitoneal o intravenosa. Nefrología. 2016;36:461–462.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy and safety of daptomycin: first in a new class of antibiotics for Gram-positive bacteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.J. 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| 2022 October | 51 | 43 | 94 |
| 2022 September | 60 | 29 | 89 |
| 2022 August | 74 | 41 | 115 |
| 2022 July | 59 | 38 | 97 |
| 2022 June | 59 | 31 | 90 |
| 2022 May | 46 | 39 | 85 |
| 2022 April | 48 | 46 | 94 |
| 2022 March | 70 | 38 | 108 |
| 2022 February | 42 | 30 | 72 |
| 2022 January | 68 | 40 | 108 |
| 2021 December | 60 | 36 | 96 |
| 2021 November | 81 | 44 | 125 |
| 2021 October | 115 | 47 | 162 |
| 2021 September | 90 | 43 | 133 |
| 2021 August | 98 | 33 | 131 |
| 2021 July | 108 | 47 | 155 |
| 2021 June | 69 | 24 | 93 |
| 2021 May | 78 | 51 | 129 |
| 2021 April | 201 | 64 | 265 |
| 2021 March | 85 | 42 | 127 |
| 2021 February | 87 | 41 | 128 |
| 2021 January | 57 | 20 | 77 |
| 2020 December | 43 | 18 | 61 |
| 2020 November | 61 | 18 | 79 |
| 2020 October | 39 | 19 | 58 |
| 2020 September | 46 | 13 | 59 |
| 2020 August | 65 | 14 | 79 |
| 2020 July | 64 | 14 | 78 |
| 2020 June | 51 | 16 | 67 |
| 2020 May | 58 | 16 | 74 |
| 2020 April | 56 | 24 | 80 |
| 2020 March | 58 | 17 | 75 |
| 2020 February | 53 | 27 | 80 |
| 2020 January | 44 | 16 | 60 |
| 2019 December | 58 | 31 | 89 |
| 2019 November | 46 | 23 | 69 |
| 2019 October | 53 | 16 | 69 |
| 2019 September | 62 | 21 | 83 |
| 2019 August | 40 | 16 | 56 |
| 2019 July | 59 | 28 | 87 |
| 2019 June | 64 | 26 | 90 |
| 2019 May | 42 | 27 | 69 |
| 2019 April | 63 | 37 | 100 |
| 2019 March | 50 | 22 | 72 |
| 2019 February | 40 | 16 | 56 |
| 2019 January | 34 | 21 | 55 |
| 2018 December | 118 | 48 | 166 |
| 2018 November | 227 | 24 | 251 |
| 2018 October | 179 | 19 | 198 |
| 2018 September | 74 | 13 | 87 |
| 2018 August | 62 | 22 | 84 |
| 2018 July | 84 | 16 | 100 |
| 2018 June | 72 | 15 | 87 |
| 2018 May | 89 | 18 | 107 |
| 2018 April | 137 | 11 | 148 |
| 2018 March | 105 | 13 | 118 |
| 2018 February | 117 | 6 | 123 |
| 2018 January | 119 | 8 | 127 |
| 2017 December | 83 | 8 | 91 |
| 2017 November | 60 | 16 | 76 |
| 2017 October | 33 | 2 | 35 |
| 2017 September | 36 | 17 | 53 |
| 2017 August | 28 | 8 | 36 |
| 2017 July | 31 | 11 | 42 |
| 2017 June | 32 | 6 | 38 |
| 2017 May | 35 | 11 | 46 |
| 2017 April | 39 | 16 | 55 |
| 2017 March | 26 | 31 | 57 |
| 2017 February | 24 | 5 | 29 |
| 2017 January | 16 | 4 | 20 |
| 2016 December | 35 | 8 | 43 |
| 2016 November | 25 | 8 | 33 |
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