Abstract: SA-PO966

Klebsiella pneumonia Renal Abscess and Peritonitis in a Peritoneal Dialysis Patient: A Novel Route of Infection

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Dhruve, Miten, University Health Network, Toronto, Ontario, Canada
  • Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada
Background

We present a route of bacterial translocation leading to peritoneal dialysis (PD) peritonitis never before reported in the literature.

Methods

A 60 year old patient with newly-diagnosed CKD of uncertain cause underwent a kidney biopsy inadvertently performed during an episode of Klebsiella urosepsis. The biopsy was consistent with advanced diabetic nephropathy and after appropriate education and preparation, a PD catheter was placed and training commenced. The patient presented soon thereafter with abdominal pain and cloudy effluent consistent with PD peritonitis. Imaging revealed a renal abscess at the biopsy site. Microbiology from the PD effluent and from needle drainage of the renal abscess were both positive for Klebsiella pneumoniae.

Conclusion

We propose that the PD peritonitis was the result of seeding of the peritoneal cavity across the retroperitoneum with bacteria from the renal abscess. Successful treatment was achieved through drainage of the abscess and intraperitoneal antibiotics.
The patient’s course is consistent with a novel route of bacterial entry into the peritoneal cavity culminating in PD peritonitis.