Abstract: TH-PO342
Pantoea dispersa Peritonitis in a Patient on Peritoneal Dialysis
Session Information
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Obi, Yoshitsugu, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Hassanein, Mohamed, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Vijayvargiya, Prakhar, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Obeidat, Khaled, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Knott, Zackary, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Dossabhoy, Neville R., The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction
Pantoea dispersa, a gram-negative bacterium belonging to the genus Pantoea, is commonly found in natural environments, including plants, soil, and water. While traditionally regarded as a plant pathogen, certain species have emerged as significant pathogens in humans, particularly in immunocompromised individuals. Here, we report a rare occurrence of Pantoea dispersa peritonitis in a patient on peritoneal dialysis (PD).
Case Description
A male in his mid-60s with end-stage kidney disease on PD presented with a two-day history of progressively worsening diffuse abdominal pain and cloudy dialysis effluent. Additional symptoms included chills, nausea, emesis, and diarrhea. Analysis of PD fluid revealed an elevated WBC (9749 cells/mm3) with neutrophil predominance (98%). We initiated empirical intraperitoneal (IP) antibiotic therapy using vancomycin and cefepime. PD fluid culture grew Pantoea dispersa from tow separate samples. Susceptibility testing showed low minimum inhibitory concentrations (MIC) to all tested antibiotics including aminoglycosides, trimethoprim/sulfamethoxazole, fluoroquinolones, and cephalosporins (cefoxitin was intermediate). Hence, the IP antibiotic regimen was changed to ceftazidime monotherapy. The patient reported significant improvement in abdominal pain by day 3, and repeat analysis of PD fluid on day 4 confirmed an excellent response to antibiotic therapy (WBC 113 cells/mm3). He was discharged with a plan to complete a 3-week course of IP ceftriaxone as outpatient.
Discussion
This case sheds light on the emerging significance of Pantoea dispersa as a pathogen in human infections, particularly in immunocompromised hosts including patients with end-stage kidney disease. Pantoea dispersa often exhibits multidrug resistance, emphasizing the importance of susceptibility testing for optimal management. Notably, Pantoea agglomerans, a related species, has been reported as a rare cause of peritonitis in PD patients, with documented complications including ultrafiltration failure and encapsulating peritoneal sclerosis. However, the consequences of Pantoea dispersa peritonitis remain unclear. By presenting this case, we hope to enhance clinicians' understanding and awareness of the potential pathogenicity of Pantoea dispersa, facilitating the establishment of effective management in similar clinical scenarios.