Coagulase-negative staphylococcal peritonitis: outcomes of cephalosporin-resistant strains.
Bibliographic record
Abstract
Peritoneal dialysis (PD) peritonitis and subsequent relapses are undesirable complications for patients requiring home peritoneal dialysis. Coagulase-negative staphylococci (CoNS) remain a common cause of peritonitis. Strains of CoNS are emerging that are resistant to cephalosporins. It has been suggested that, if sensitivity testing shows resistance to cephalosporin but the patient is improving on intraperitoneal cephalosporin, then there is no need to change the antibiotic. The rationale for this approach is that the intraperitoneal concentration of cephalosporin is higher than concentrations used in the microbiology laboratory to determine sensitivity or resistance. Previously, we reviewed a smaller number of cases of CoNS and noted that the relapse rate seemed greater for strains with cephalosporin "resistance" initially treated with cephalosporins. The present retrospective review looks at the incidence and treatment of CoNS peritonitis reported as resistant to cephalosporins in a large urban PD program between January 1, 2006, and August 31, 2009. During the study period, 200 new cases of peritonitis occurred, 65 of which (32.5%) were identified as CoNS. All were treated empirically with cefazolin (or vancomycin if allergic) for gram-positive coverage and either tobramycin or ceftazidime for gram-negative coverage. Of the 65 CoNS cases, 27 (41.5%) were sensitive to cefazolin; 38 (58.5%) were reported to be cephalosporin-resistant. Of the 38 episodes of CoNS reported as resistant, 10 were treated throughout with cephalosporin, and 28 either started with or were changed to vancomycin. Of the 28 treated with vancomycin only, 2 relapsed, which compares with 4 of 10 who were treated with cephalosporin throughout (Fisher exact test p = 0.03) Our study suggests that, although cephalosporin-resistant cases of CoNS initially resolve with cephalosporin treatment, they are indeed associated with a greater risk of relapse. Patients with CoNS peritonitis reported resistant to cefazolin may benefit from a change to vancomycin to reduce the risk of relapse.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".