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Abstract: TH-PO811

Unusual Pathogens in Usually Encountered Infections in ESRD

Session Information

Category: Pathology and Lab Medicine

  • 1800 Pathology and Lab Medicine


  • Athavale, Bahaar Shirish, Bombay Hospital and Medical Research Centre, Mumbai, MH, India
  • Shah, Hardik, Bombay Hospital and Medical Research Centre, Mumbai, MH, India
  • Ramteke, Akshay Prakash, Bombay Hospital and Medical Research Centre, Mumbai, MH, India
  • Kirpalani, Dilip, Bombay Hospital and Medical Research Centre, Mumbai, MH, India

In this case series of ESRD patients, we aim to highlight serious infections caused by pathogens hitherto not commonly encountered in India.

Case Description

Aeromonas hydrophila, found in aquatic environment was isolated from biopsy of non healing leg wound (prior cultures being negative) in a transplant recipient, who responded only after an appropriate 6 week antibiotic course. Serratia marcescens, found in water and soil, was isolated from BAL of a transplant recipient with cavitatory pneumonia and from a tunnelled catheter in a HCV positive patient on MHD with CRBSI. Both patients did not exhibit positive cultures from prior samples and responded only to Meropenem (other higher antibiotics being resistant). Morganella morganii, part of normal flora in humans, was grown from tunnelled catheter of a patient on MHD with fever of unknown origin (other workup of FUO being inconclusive), needing catheter removal due to pan resistance. Elizabethkingia meningoseptica, a commensal in healthcare facilities, was isolated from non tunnelled HD catheter, and needed Colistin therapy as the only available choice. Geotrichum species, a contaminant of fruits & vegetables was finally isolated from tunnelled catheter of a patient with CRBSI with 2 negative blood cultures previously over 3 weeks. A 54/F patient needed CAPD catheter removal due to Candida tropicalis infection and 3 months later needed tunnelled catheter removal due to Candida parapsilosis (a common skin flora and a subungual proliferator) infection. Both above organisms were resistant to Azoles and Echinocandins.


These unusual organisms residing in soil, water, disinfection solutions and surfaces in dialysis units need active surveillance and timely microbiological detection as they are likely to increase morbidity and mortality in ESRD. Tackling the double whammy of newer pathogens and depleting arsenal of sensitive antibiotics is a big challenge in developing countries. High index of clinical suspicion and state of the art diagnostic facilities for detecting causative pathogens is the need of the hour.