Successful treatment of PD peritonitis due to brevundimonas vesicularis

Brevundimonas vesicularis is a rare cause of peritoneal dialysis-associated peritonitis (PD peritonitis). One documented case report described poor outcome despite treatment with appropriate antibiotics. Here, we report the successful treatment of PD peritonitis due to Brevundimonas vesicularis with 21 days of intraperitoneal (IP) antibiotics using the regimen described for Pseudomonas aeruginosa, notably IP gentamicin (10 days) followed by IP cefepime and oral ciprofloxacin (11 days). Despite the favorable outcome, measurement of antibiotic concentrations in the PD effluent suggests that the cefepime and possibly ciprofloxacin regimens do not achieve key antibiotic concentration targets that are reported to maximize bacterial kill. The role of routine therapeutic drug monitoring to maximize clinical outcomes from antibiotic therapy for PD peritonitis requires further consideration.