Chemical peritonitis associated with intraperitoneal vancomycin: A case series
Authors:   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal, Silvano José ,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Pereira Luciano ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Oliveira Ana ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Beco Ana ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Relvas Miguel ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Silva Rui ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal, Pestana Manuel ,   Nephrology department, Centro Hospitalar e Universitário da São João. Porto, Portugal,   Nephrology & Infectious Diseases R&D, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal,   Faculty of Medicine, University of Oporto, Porto, Portugal
Published: July 2021

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.