A Case of Cellulosimicrobium Peritonitis Associated with Peritoneal Dialysis
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Bodker, Kevin, Medical University of South Carolina, Charleston, South Carolina, United States
While peritoneal dialysis (PD) associated peritonitis is common, isolation of an uncommon organism can pose a clinical challenge. We present a case of PD peritonitis caused by the organism Cellulosimicrobium. A review from 2019 by Rivero et al found only 43 described cases of infection due to Cellulosimicrobium. Two-thirds of described cases were associated with an indwelling medical foreign body, and only 5 cases described associated with PD.1
A 71-year-old male presented with acute coronary syndrome and hypervolemia. Nephrology was consulted for PD management. During evaluation for coronary artery bypass graft (CABG) patient was transitioned from PD to Continuous Hemodiafiltration, requiring aggressive ultrafiltration. CABG was complicated by protracted cardiogenic shock. Unresolving shock and leukocytosis raised concern for concurrent sepsis, broad-spectrum antibiotics (vancomycin and cefepime IV) and infectious workup were pursued. PD fluids were consistent with peritonitis and cultures were positive for Cellulosimicrobium. Despite 10 days of vancomycin cultures remained positive. Persistent clinical instability delayed removal of PD catheter, which was removed on day 20. Patient was successfully transitioned to hemodialysis and remained without evidence of persistent infection at discharge.
Despite vancomycin sensitivity in all previously described cases of infection attributed to this organism, two weeks of IV administration failed to clear the infection in our case.1 This is consistent with the five published cases of Cellulosimicrobium described in the literature (fig 1), where three out of five cases were considered antibiotic failure and required PD catheter removal. Depending on the clinical context, removal of PD catheter should be considered early in the treatment course of Cellulosimicrobium peritonitis given high rate of treatment failure.