The American Journal of Medicine
Volume 76, Issue 6 , Pages 1035-1040, June 1984

Intraleukocytic sequestration as a cause of persistent Staphylococcus aureus peritonitis in continuous ambulatory peritoneal dialysis☆

  • Brian P. Buggy, M.D.

      Affiliations

    • From the Divisions of Infectious Diseases and Nephrology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
    • Current address: Department of Medicine, Medical College of Wisconsin and St. Luke's Hospital, 2900 West Oklahoma Avenue, Milwaukee, Wisconsin 53215.
    • ,
  • Dennis R. Schaberg, M.D.

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Dr. Dennis R. Schaberg, Division of Infectious Diseases, R-6022 Kresge II, University of Michigan, Ann Arbor, Michigan 48109.
    • From the Divisions of Infectious Diseases and Nephrology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
    • ,
  • Richard D. Swartz, M.D.

      Affiliations

    • From the Divisions of Infectious Diseases and Nephrology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.

Ann Arbor, Michigan USA

Accepted 13 February 1984.

Abstract 

Peritonitis caused by Staphylococcus aureus in four patients undergoing continuous ambulatory peritoneal dialysis failed to respond to, or relapsed immediately after cessation of, intraperitoneal antibiotic therapy with vancomycin or cephalothin and tobramycin. Sequestration of viable staphylococci within polymorphonuclear leukocytes in the peritoneal fluid was suspected for two reasons: (1) staphylococci could still be grown after treatment of the dialysate cell fraction with lysostaphin, a procedure that kills only extracellular staphylococci, and (2) diminished polymorphonuclear leukocyte bactericidal activity was demonstrated in peritoneal dialysis effluent. Addition of rifampin, which readily penetrates polymorphonuclear leukocytes, to the treatment regimen of all patients led to prompt resolution of peritonitis without relapse.

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☆ This work was supported by the Frederick Novy Infectious Diseases Research Fund of the University of Michigan and by Grant AI-19277 from the National Institutes of Health.

PII: 0002-9343(84)90854-4

The American Journal of Medicine
Volume 76, Issue 6 , Pages 1035-1040, June 1984

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