Antibiotic administration via indwelling peritoneal catheter to treat infected malignant ascites

Our plain-English summary of Antibiotic administration via indwelling peritoneal catheter to treat infected malignant ascites, by T. Jayawardena, S. Vekaria, S. Krivinskas, et al (Respirology Case Reports, 2022).

The study

• Authors: T. Jayawardena, S. Vekaria, S. Krivinskas, C. Sidhu, A. Chakera, Y.C.G. Lee
• Journal: Respirology Case Reports
• Published: 2022;10(11):e01055
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Indwelling pleural catheter is an established management for malignant pleural effusions. Extending its use to patients with malignant ascites by insertion of a catheter intraperitoneally enables regular outpatient drainage and improves quality-of-life. However, indwelling pleural/peritoneal catheter (IPC/IPeC) is associated with catheter-related infections, traditionally managed with systemic antibiotics and occasionally requires catheter removal. Direct administration of antibiotics intra-abdominally via peritoneal dialysis (PD) catheters is a well-established, efficacious practice in PD-related peritonitis and minimizes systemic adverse effects. We applied the same principles to a patient with peritoneal mesothelioma who developed peritonitis 3 weeks after insertion of IPeC. Intraperitoneal vancomycin was administered via, and compatible with, the IPeC. The patient tolerated the treatment without adverse effects and made a full recovery without requiring catheter removal.

© 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report described one 57-year-old man with peritoneal mesothelioma. He had a catheter left in his abdomen to drain fluid that the cancer kept producing. Three weeks later he developed peritonitis, an infection of the abdominal lining, caused by methicillin-sensitive Staphylococcus aureus. He first received the antibiotics piperacillin/tazobactam and vancomycin through a vein. After 24 hours his C-reactive protein, a marker of inflammation, had risen to 277 mg/L. The doctors then switched the vancomycin to daily doses given through the catheter into the abdomen, while intravenous piperacillin/tazobactam continued. He received four such doses with no reported adverse events, and his daily trough (lowest-point) blood vancomycin levels stayed below 10 mg/L. Cultures of his abdominal fluid turned negative 48 hours after the switch. He left hospital on day eight without the catheter being removed. The authors concluded that the case highlights the safety and feasibility of giving antibiotics through the catheter. They noted that, because he also received antibiotics through a vein, it is unclear how much the catheter-delivered vancomycin contributed. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 57-year-old man with peritoneal mesothelioma and recurrent malignant ascites. The authors are based in Perth, Western Australia, but the article does not state where the patient was treated.
• Exposure: The article does not mention asbestos or any occupational exposure. The intervention studied was vancomycin 1.5 g given once daily into the peritoneal cavity through the indwelling peritoneal catheter, alongside intravenous piperacillin/tazobactam.
• Main results:
  • The patient's peritoneal infection was methicillin-sensitive Staphylococcus aureus.
  • After 24 hours of intravenous antibiotics, the patient's C-reactive protein rose to 277 mg/L.
  • The patient received four daily intraperitoneal vancomycin doses through the catheter, and no adverse events were reported.
  • The patient's daily serum trough vancomycin levels stayed below 10 mg/L, which the authors took to indicate no significant buildup in the body.
  • The patient's C-reactive protein fell to 125 mg/L and his abdominal discomfort improved.
  • The patient's peritoneal fluid cultures became negative 48 hours after intraperitoneal vancomycin was started.
  • The patient was discharged on day eight and completed a 14-day course of intravenous piperacillin/tazobactam.
  • The patient's catheter was eventually removed after 20 months in place, following a later post-operative abscess.
• The authors' conclusion: The authors concluded that the case highlights the safety and feasibility of giving antibiotics through the indwelling peritoneal catheter, and that further study is needed on dosing and patient selection.
• Limitations the authors state:
  • Because systemic (intravenous) antibiotics were given at the same time, it is unclear how much the intraperitoneal vancomycin contributed to clearing the infection.

Topics

Medical terms in this study, explained in our Lexicon: Ascites, Indwelling Pleural Catheter, Pleural Effusion, Peritoneal Mesothelioma.

Related studies

• Australasian Malignant PLeural Effusion (AMPLE)-3 trial: study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion — D.B. Fitzgerald, C. Sidhu, et al. (2022)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Catheter tract metastasis associated with indwelling pleural catheters — R. Thomas, C.A. Budgeon, et al. (2014)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)
• Complications of indwelling pleural catheter use and their management — M.M. Lui, R. Thomas, et al. (2016)

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