Once-daily intraperitoneal gentamicin is effective therapy for gram-negative CAPD peritonitis

Objective:To report our 3-year experience with the use of once-daily intrap eritoneal (IP) gentamicin in the treatment of gram-negative continuous ambu latory peritoneal dialysis (CAPD) peritonitis. Design: A prospective cohort study in prevalent CAPD patients. Setting: A tertiary care institution. Patients: All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamici n were administered as empirical therapy. IP gentamicin was given at a sing le daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents w ere reviewed when the culture results became available. Intraperitoneal cef tazidime was added for the treatment of pseudomonas peritonitis. Main Outcome Measures: Results of microbiological cultures and clinical out comes of peritonitis were analyzed. Results: Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gra m-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%) ; Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatm ent success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudom onas infections and gentamicin-resistant pathogens were excluded. Conclusions: Once-daily IP gentamicin appears to be effective in the treatm ent of gram-negative CAPD peritonitis.