{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:06:38Z","timestamp":1789153598901,"version":"build-2803163510"},"reference-count":20,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    A man in his 60s presented with\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    peritoneal dialysis (PD)-associated peritonitis. Despite appropriate therapy, his effluent leucocyte count, though downward trending, remained &gt;2000\/\u00b5L on day 5, meeting criteria for refractory peritonitis and prompting recommendation for PD catheter removal. This option was declined by the patient because of his poor premorbid condition and high procedural risk. As treatment continued, a steady further downward trend in effluent leucocytes emerged, and catheter preservation was pursued. Intraperitoneal amikacin was added to intravenous ceftriaxone, providing dual-route, dual-class antimicrobial therapy. Unexpectedly, his peritonitis resolved by day 15 without catheter removal. He was discharged eventually.\n                  <\/jats:p>\n                  <jats:p>This case illustrates that PD catheter removal may not always be practical in frail patients. Trends in effluent leucocyte counts may offer more clinical insight than a strict absolute threshold for catheter removal. It raises the hypothesis that combined intravenous and intraperitoneal antibiotics may be beneficial in selected gram-negative infections.<\/jats:p>","DOI":"10.1136\/bcr-2025-271334","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:15:23Z","timestamp":1789150523000},"page":"e271334","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Medical resolution of refractory peritoneal dialysis-associated peritonitis without catheter removal"],"prefix":"10.1136","volume":"19","author":[{"given":"Mabel","family":"Tan","sequence":"first","affiliation":[{"name":"Renal Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saradha","family":"Anantharaman","sequence":"additional","affiliation":[{"name":"Renal Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiting","family":"Ong","sequence":"additional","affiliation":[{"name":"Renal Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debajyoti","family":"Roy","sequence":"additional","affiliation":[{"name":"Renal Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091111151840000_19.9.e271334.1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit Dial Int"},{"key":"2026091111151840000_19.9.e271334.2","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2016.00078"},{"key":"2026091111151840000_19.9.e271334.3","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1177\/089686080202200508","article-title":"Predictors of outcome following bacterial peritonitis in peritoneal dialysis","volume":"22","author":"Krishnan","year":"2002","journal-title":"Perit Dial Int"},{"key":"2026091111151840000_19.9.e271334.4","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01010306"},{"key":"2026091111151840000_19.9.e271334.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2009.07.016"},{"key":"2026091111151840000_19.9.e271334.6","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2003.08.046"},{"key":"2026091111151840000_19.9.e271334.7","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/sdi.13202","article-title":"Risk Factors of the Occurrence and Treatment Failure of Refractory Peritoneal Dialysis-Associated Peritonitis: A Single-Center Retrospective Study From China","volume":"37","author":"Liang","year":"2024","journal-title":"Semin Dial"},{"key":"2026091111151840000_19.9.e271334.8","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.xkme.2020.04.010","article-title":"Peritoneal Dialysis-Associated Peritonitis: Suggestions for Management and Mistakes to Avoid","volume":"2","author":"Al Sahlawi","year":"2020","journal-title":"Kidney Med"},{"key":"2026091111151840000_19.9.e271334.9","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1002\/ccr3.3649","article-title":"Successful treatment of Serratia Marcescens peritonitis in a patient receiving peritoneal dialysis","volume":"9","author":"Yang","year":"2021","journal-title":"Clin Case Rep"},{"key":"2026091111151840000_19.9.e271334.10","doi-asserted-by":"crossref","unstructured":"Azzam O , Crowe A , Sajiv C , et al . Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Australia. BMJ Case Rep 2015;2015. doi:10.1136\/bcr-2014-207753","DOI":"10.1136\/bcr-2014-207753"},{"key":"2026091111151840000_19.9.e271334.11","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2013.00111"},{"key":"2026091111151840000_19.9.e271334.12","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2012.00163"},{"key":"2026091111151840000_19.9.e271334.13","doi-asserted-by":"crossref","unstructured":"Tantiyavarong P , Traitanon O , Chuengsaman P , et al . Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis. 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