Gentamicin
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Development of resistance in Pseudomonas infections: 2 case reports A 73-year-old man developed a resistant Pseudomonas sp. infection following dialysis exit-site infection prophylaxis with gentamicin, while a 70-year-old woman developed resistance to gentamicin after treatment for a P. aeruginosa exit-site infection [dosage information incomplete; duration of treatments not clearly stated]. The man started automated peritoneal dialysis for endstage renal disease in July 2007, and was administered topical gentamicin to the exit site for infection prophylaxis every dressing change. In October 2007, he developed a coagulase-negative Staphylococcus exit-site infection which was treated with vancomycin. Gentamicin was switched to mupirocin for infection prophylaxis. In September 2008, he administered the remainder of his topical gentamicin for infection prophylaxis due to a delay in refilling his mupirocin prescription. In October 2009, he presented with pain and purulent discharge at the exit site. Culture revealed a Pseudomonas sp., which was resistant to gentamicin. He received ciprofloxacin for 2 weeks, and the exit-site infection resolved. The woman started peritoneal dialysis for end-stage renal disease in December 2007. In November 2008, she presented with a tender and erythematous exit site. Culture revealed P. aeruginosa, which was sensitive to gentamicin. She received topical gentamicin daily for 7 days. She responded well to treatment, and she subsequently received gentamicin ointment for exit-site prophylaxis. One month later, she developed recurrence of exit-site erythema. Culture grew P. aeruginosa, and she received ciprofloxacin and tobramycin. Her infection subsequently resolved. In March 2009, she developed a third Pseudomonas sp. exit-site infection, and she received ciprofloxacin and tobramycin. She was subsequently treated with antibacterials and avoidance of catheter removal and replacement. Over the next few weeks, her exit site improved. However, 1 month later, her exit site became inflamed again. Culture grew P. aeruginosa, which was resistant to gentamicin, but sensitive to tobramycin [outcome not stated]. Author comment: "Our findings support the hypothesis that routine topical application of gentamicin may promote the development of resistant organisms in a subset of patients." Nessim SJ, et al. Gentamicin-resistant infections in peritoneal dialysis patients using topical gentamicin exit-site prophylaxis: A report of two cases. Peritoneal Dialysis International 32: 339-341, No. 3, May-Jun 2012. Available from: URL: 803076083 http://dx.doi.org/10.3747/pdi.2011.00224 - Canada
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Reactions 1 Sep 2012 No. 1417
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