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Abstract: FR-PO566

Actinomyces neuii Peritonitis in Peritoneal Dialysis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Oo, Swe Zin Mar Win Htut, University of Iowa, Iowa City, Iowa, United States
  • Patel, Jayesh B., University of Iowa, Iowa City, Iowa, United States
  • Swee, Melissa L., University of Iowa, Iowa City, Iowa, United States
Introduction

Due to impaired immunity and increased microbial exposure, peritonitis is the most common complication seen in peritoneal dialysis (PD). Although staphylococcal infections are most common, a variety of other microorganisms can colonize and subsequently infect the peritoneal cavity. We report a case of continuous ambulatory peritoneal dialysis (CAPD) peritonitis due to Actinomyces neuii.

Case Description

A 71-year-old female with end-stage renal disease on home continuous cycler peritoneal dialysis and prior history of clostridium difficile colitis presented with two days of severe watery diarrhea and severe abdominal cramps. Vital signs were stable and examination was notable for abdominal distention and cloudy PD fluid. Stool samples were positive for C. diff and gram-positive bacteria were identified in PD fluid. She was prescribed oral metronidazole and intraperitoneal vancomycin. Final fluid cultures were positive for Actinomyces neuii susceptible to Vancomycin and have been successfully treated with 2 weeks of vancomycin. We educated her on the importance of hand hygiene and sterile technique.

Discussion

Actinomyces is a gram-positive bacillus comprising normal gut flora. It is rarely associated with soft tissue infections, but may occur in those with impaired immunity. Because the peritoneal cavity lacks robust innate immune responses, it is a favored site for infection. We speculate that increased bacterial translocation from the gut due to colitis or contamination of the PD catheter may have contributed to the peritonitis. Actinomyces is a likely underrecognized cause of peritonitis in PD patients due to its fastidious nature, but identification is important because actinomyces infections may be indolent and may not respond to repeated short courses of antibiotics. If left untreated, sinus tracts and abscesses may form, which can lead to secondary infections.