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Abstract: PO1284

Polymicrobial Peritoneal Dialysis Peritonitis due to Eggerthella lenta, Parabacteroides Species, and Bacteroides distasonis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Gerardine, Supriya, New York Presbyterian -Weil Cornell, New York, New York, United States
  • Srivatana, Vesh, Rogosin Institute, New York, New York, United States
Introduction

Peritionitis is a severe and common infectious complication among patients on peritoneal dialysis (PD). Most cases are due to Coagulase negative staphylococcus.Anaerobic bacteria constitute < 0.5% of the peritonitis in PD patients.This is a case of anaerobic polymicrobial PD peritonitis of rare pathogens without a clear intrabdominal source.

Case Description

92 year old man with end stage renal disease who had a failed deceased donor renal transplant and was started on peritoneal dialysis 6 months ago was admitted for abdominal pain with cloudy peritoneal fluid for 3 days.
Peritoneal fluid had cell count of 22,000 cells/ul . He was treated with intraperitoneal (IP) vancomycin and ceftazidime with improvement in abdominal pain and cell count downtrended to 2700/ul on Day four he was discharged with continued IP antibiotic administration.He was re-admitted in two days for worsening abdominal pain with a cell count of 14,000/ul. Patient had been correctly administering IP antibiotics with the assistance from his family members. CT abdomen pelvis with intravenous and oral contrast showed small bowel ileus likely due to the peritonitis. At this time the peritoneal dialysis catheter was removed and he was converted to hemodialysis.
The peritoneal fluid cultures on Day 7 resulted Eggerthela Lenta and on Day 10 grew Parabacteroides species. Upon review his initial PD fluid culture prior to transfer from outside hospital was positive for Bacteroides Distastonis. Sensitivities were reported for only Eggerthela Lenta and Parabateroides species and they were both sensitive to metronidazole. Antibiotics were broadened to intravenous vancomycin, ceftazidime and metronidazole with clinical improvement in patient.

Discussion

To our knowledge, this is the first case of bacterial peritonitis from Parabacteroides species and Bacteroides Distastonis.
There is only one case report of Eggerthela Lenta reported by Goupil et al. causing PD peritonitis.The PD fluid culture was slow growing and this highlights the potential need for anaerobic coverage in PD peritonitis without early pathogen isolation and/or failure of initial empiric treatment.