Abstract: FR-PO486
Peritoneal Dialysis Peritonitis With Acinetobacter pittii
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Bajaj, Tushar, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
- Ismail, Nader, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
- Trivedi, Anuja, Jackson Park Hospital Foundation, Chicago, Illinois, United States
- Sarav, Menaka, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
Introduction
Acinetobacter baumanii has been reported as an uncommon cause of PD-peritonitis; however, we report the first case of PD-peritonitis caused by A. pittii.
Case Description
A 49 YO AA Male with ESRD on PD, HTN, and morbid obesity presented with a 4 day history of nausea, emesis, and diffuse abdominal pain. PD fluid was collected as outpatient and patient was started on intraperitoneal (IP) cefazolin and IP ceftazidime. Patient was PD dependent for two years, never had a prior similar episode, and was oliguric. The patient was not using the sterile aseptic technique as per usual, rather using dish towels to wipe his hand before and after accessing the transfer set. Physical exam pertinent for a distended abdomen, tenderness to light palpation, positive fluid wave, and dullness to percussion. Labs significant for leukocytosis, hypokalemia, and elevated anion gap. Records from initial sample identified organism as Acinetobacter pittii. Table 1 demonstrates the fluid characteristics by day. Empirically IP ceftazidime and IP gentamicin was started; however, sensitivity to ceftazidime returned at 4mcg/mL. Patient was started on IP Ceftazidime as last fill for 3 weeks initially; however, increased to 4 weeks due to persistent cloudy effluent. Unfortunately, readmitted to the hospital with abdominal pain, tachycardia, and tachypnea. Due to concerns for sepsis, increased peritoneal fluid count with the same organism, the PD catheter was subsequently removed, patient was placed on IV antibiotics and discharged with intermittent hemodialysis.
Discussion
Acinetobacter pittii is a strictly aerobic, gram-negative, non-motile, non-lactose fermenting, oxidase negative, catalase positive coccobacilli. Infections outside hospital settings are rare with such organisms, hand hygeine and infection control practices are crucial to reduce incidence. Common presentations of acinetobacter peritonitis include abdominal pain, cloudy dialysate fluid, and fever. Our case is important to demonstrate a rare cause of PD peritonitis, the importance of hand hygiene with sterile technique, and elucidate treatment failure.
Fluid Characteristics by Day
| Day 1 | Day 4 | Day 8 | Day 28 | |
| Fluid Color | Yellow | Colorless | Colorless | Yellow |
| Appearance | Cloudy | Clear | Clear | Cloudy |
| Fluid TNC | 93557 | 998 | 213 | 43245 |
| Neutrophil % | 80 | 54 | 57 | 80 |