Use of high doses of intraperitoneal amikacin to preserve the peritoneal catheter during pseudomonas peritonitis

This article reports a clinical case illustrating the use of high-dose intraperitoneal amikacin to preserve the peritoneal catheter in a patient with Pseudomonas aeruginosa peritonitis undergoing chronic peritoneal dialysis. Pseudomonas peritonitis is known for its severity, poor response to standard treatments, and high probability of leading to catheter removal, often resulting in a harmful transition to hemodialysis.The patient, aged 46, with stage V renal failure secondary to HIV-associated nephropathy, had been treated with continuous ambulatory peritoneal dialysis since 2021. After an episode of Pseudomonas peritonitis in 2023, which was successfully treated, he presented in 2024 with a recurrence associated with an infection at the catheter exit site. Despite empirical and then targeted antibiotic therapy in accordance with ISPD recommendations (cephalosporin, gentamicin, then cefepime and ciprofloxacin, then meropenem instead of cefepime), the biological progression remained unfavorable, with persistently high cellularity in the peritoneal fluid.Given this lack of response, high-dose intraperitoneal amikacin bolusesup to 12 mg/kg) were administered. Each injection was followed by a marked decrease in peritoneal cellularity, although there was an initial rebound requiring repeated administrations. After a third and final lower dose, complete normalization of the dialysis fluid was achieved without removal of the catheter.No adverse effects, particularly auditory or vestibular, were observed in the short or medium term, although no systematic audiometry was performed at a distance. The authors emphasize the pharmacodynamic interest of intraperitoneal administration, which enables high local concentrations well above the MIC while limiting systemic exposure.In conclusion, this case suggests that the exceptional use of high intraperitoneal doses of amikacin may represent an effective rescue option in selected patients, when catheter removal is associated with a high risk of morbidity and mortality.