101 PDI january 2013 - VoL. 33, no. 1 COrrESPOnDEnCE Treatment of L. garvieae infection is similar to that for a streptococcal infection, but most cases require prolonged treatment (4). regimens including ampicillin or amoxicillin, ceftriaxone, netilmicin, and vancomycin or teicoplanin have been successfully administered (2–5). However, it is also important to differentiate L. garvieae infection from other streptococcal infec- tions, because the former organisms are generally resistant to clindamycin, but the latter are not (10). Our patient received IP cefazolin, and the response was also acceptable. DISCLOSUrES The authors have no financial conflicts of interest to declare. C.T. Chao C.F. Lai J.W. Huang* Division of nephrology Department of Internal Medicine national Taiwan University Hospital Taipei, Taiwan *email: 007378@ntuh.gov.tw rEFErEnCES 1. Wang CY, Shie HS, Chen SC, Huang JP, Hsieh IC, Wen MS, et al. Lactococcus garvieae in humans: possible asso- ciation with aquaculture outbreaks. Int j Clin Prac 2007; 61:68–73. 2. Yiu KH, Siu CW, To KK, Jim MH, Lee KL, Lau CP, et al. A rare cause of infective endocarditis: Lactococcus garvieae. Int j Cardiol 2007; 114:286–7. 3. Mofredj A, Baraka D, Kloeti G, Dumont JL. Lactococcus garvieae septicemia with liver abscess in an immunosup- pressed patient. am j Med 2000; 109:513–14. 4. Chan JF, Woo PC, Teng JL, Lau SK, Leung SS, Tam FC, et al. Primary infective spondylodiscitis caused by Lactococcus garvieae and a review of human L. garvieae infections. Infection 2011; 39:259–64. 5. James Pr, Hardman SM, Patterson DL. Osteomyelitis and possible endocarditis secondary to Lactococcus garvieae: a first case report. Postgrad Med j 2000; 76:301–3. 6. Eldar A, Goria M, Ghittino C, Zlotkin A, Bercovier H. Biodi- versity of Lactococcus garvieae strains isolated from fish in Europe, Asia, and Australia. appl Environ Microbiol 1999; 65:1005–8. 7. Devriese LA, Hommez J, Laevens H, Pot B, Vandamme P, Haesebrouck F. Identification of aesculin-hydrolyzing streptococci, lactococci, aerococci and enterococci from subclinical intramammary infections in dairy cows. Vet Microbiol 1999; 70:87–94. 8. Fortina MG, ricci G, Foschino r, Picozzi C, Dolci P, Zeppa G, et al. Phenotypic typing, technological properties and safety aspects of Lactococcus garvieae strains from dairy environments. j appl Microbiol 2007; 103:445–53. 9. Kubota H, Tsuji H, Matsuda K, Kurakawa T, Asahara T, no- moto K. Detection of human intestinal catalase-negative, gram-positive cocci by rrnA-targeted reverse transcrip- tion–PCr. appl Environ Microbiol 2010; 76:5440–51. 10. Elliott JA, Facklam rr. Antimicrobial susceptibilities of Lactococcus lactis and Lactococcus garvieae and a proposed method to discriminate between them. j Clin Microbiol 1996; 34:1296–8. doi:10.3747/pdi.2012.00078 ofloxacin solution for Persistent exit-site and Tunnel Infection in Peritoneal Dialysis KEY WOrDS: Ofloxacin solution; exit-site infection; tunnel infection; Tenckhoff catheter. Editor: Infections of the Tenckhoff catheter exit site and tun- nel require antibiotic therapy to treat the infection and to prevent progression to peritonitis (1,2). In general, 2 – 3 weeks of an oral antibiotic eradicates the infection (1). We describe 2 cases of persistent infection (1 of the exit site and 1 of the tunnel) involving an exposed PD catheter outer cuff. CASE DESCrIPTIOnS Case 1 involved a 50-year-old African American man with an abdominal PD catheter. He had 2 episodes of tunnel infection 2 months apart that grew Pseudomonas aeruginosa. Case 2 involved a 70-year-old African American woman with a presternal PD catheter. She initially grew methicillin-resistant Staphylococcus aureus (MrSA) and P. aeruginosa. One month later she grew MrSA and achromobacter xylosoxidans. Both patients were treated with oral ciprofloxacin 500 mg for 14 days with resolution of the initial infec- tion. However, the infection recurred within a short period, with an exposed PD catheter outer cuff. For the surgeon to shave the exposed cuff, the infection had to be cleared. As a supplement to oral antibiotics, 2 drops of ofloxacin otic solution 0.3% was instilled twice daily into the lumen containing the PD catheter to treat the second episode of infection. This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at marketing@multi-med.com.