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Abstract: FR-PO484

A Rare Case of Bacterial Peritonitis Caused by Ralstonia mannitolilytica in an Adult Peritoneal Dialysis Patient

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • Thomas, Litty, The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States
  • Saxena, Ramesh, The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States

Peritonitis is associated with a high risk of morbidity and technique failure, mostly caused by gram-positive or gram-negative commensals. Rarely, PD patients can develop peritonitis from an unusual bacteria. We describe a case of peritonitis caused by Ralstonia mannitolilytica. To our knowledge, this is the first reported case of Ralstonia peritonitis in an adult PD patient.

Case Description

A 67-year-old woman with a history of end-stage kidney disease due to obstructive uropathy from renal tuberculosis, status post-Left nephrectomy, and right PCN has been on PD for 12 years, chronic Hepatitis B, atrial fibrillation, type II diabetes, and hypertension, presented to the ED a day after her routine colonoscopy with severe abdominal pain, and cloudy urinary output from the PCN. She was started on empiric antibiotic therapy. Peritoneal fluid studies were done and were consistent with peritonitis. Peritoneal fluid culture grew E.coli. Urine culture from the right PCN also grew E.coli. She was treated with a 3-week course of intraperitoneal (IP) cefazolin and ceftazidime with the resolution of peritonitis.

The patient presented to the PD clinic with recurrent symptoms 2 weeks after the resolution of 1st peritonitis. PD fluid analysis was consistent with gram-negative rods. Final culture and sensitivity results showed Ralstonia species, which is pan-sensitive. She was treated for 3 weeks with cefepime and gentamycin IP with complete resolution of peritonitis.

She presented to the ED again due to persistent abdominal pain, N/V. The PD fluid analysis confirmed the third episode of peritonitis. During the 3rd episode of peritonitis, the Ralstonia species was resistant to most antibiotics which were sensitive during the prior episodes. Based on the sensitivities she was treated with oral Bactrim. Recurrent infection with the same organism even after treating with appropriate antibiotics and duration raised the concern of PD catheter seeding of the organism. Hence, the PD catheter was removed, and the patient was started on hemodialysis.


Ralstonia is Gram-negative bacteria that have the ability to pass through the filters used to sterilize the solutions, resistant to hospital disinfectants, and moreover, a tendency to form a biofilm that enhances the organism’s survival and likely plays a role in their frequent antibiotic resistance.