A. DAIR
B. One stage exchange arthroplasty
C. Two stage exchange arthroplasty
D. Permanent Resection with antibiotics spacer

But if you don't know it is not ESBL, based on the abx susceptibility panel alone, it looks like an ESBL producer based on ceftriaxone Resistance. Would you still use cefepime?

pubmed.ncbi.nlm.nih.gov/33987537/

If you have a large volume of PD patients, and you don’t do this, you will see fungal peritonitis

It’s a 1B from @ispd1.bsky.social www.nephjc.com/news/ispd202...

I can’t imagine the replies which say you need not 🤦🏽‍♂️

Also came up on the pod: www.nephjc.com/freelyfilter...

I tend not to but understand if people do it. Once patients get fungal peritonitis the nephrologists tend to remove the catheter and put them on HD which can have a big impact on QoL.

This is perhaps a more common reason to explain this phenomenon, the case of a polymicrobial culture in which one has mecA gene. But as Alice shared, at least 3% could occur in monomicrobial infection with a Staph aureus mec A gene positive but oxacillin susceptible

I really didn’t know heteroresistance in staph aureus was also a thing. But the lab is supposed to report as R if mec A gene found.

pmc.ncbi.nlm.nih.gov/articles/PMC...

journals.asm.org/doi/10.1128/....

In theory, at least in vitro and one case report, it could develop reversion to oxacillin resistance upon exposure to beta lactams

Its imperfect data. But its some data and it suggests benefit. 5% absolute reduction in the RCT.

I consider this to be a fairly low risk, high reward intervention. Short courses of fluc are generally well tolerated and there is evidence of benefit that's better than many things we do in ID

I usually follow the kidney society guidelines for PD peritonitis, which does recommend it.

There is some evidence to support its use, albeit not the highest quality:
Cochrane Review: pmc.ncbi.nlm.nih.gov/articles/PMC...
SR/MA: www.sciencedirect.com/science/arti...