Dialysis-Associated <i>Alcaligenes Xylosoxidans</i> Peritonitis: A Pediatric Case

Melgosa, Marta; Espinazo, Oscar; Alonso, A.; Perea, Adela García; Navarro, Mercedes

doi:10.1177/089686080402400110

Cited by 10 publications

(10 citation statements)

References 5 publications

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“…One reason was the inexperienced skills for PD (such as case 5 with blindness [ 9 ] ). Half of the AX infections in PD were more than 1 peritonitis (5 times peritonitis for 2 cases and 7 times peritonitis for 1 case [ 4 ] ). Finally, AX contaminated water without thorough disinfection was also the major problem.…”

Section: Discussionmentioning

confidence: 99%

Case report

Tsai

2017

Medicine

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Rationale:Achromobacter xylosoxidans infection is mostly reported in immunocompromised patients. Until now, it is still rarely reported in patients undergoing peritoneal dialysis.Patient concerns:This is the 1st case of A xylosoxidans infection due to tunnel infection of a Tenckhoff catheter.Diagnosis:The diagnosis was confirmed by the report of culture.Interventions:Risk factors for this infection in peritoneal dialysis include uremia with an immunocompromised state, contamination due to inexperienced skills, and aqueous environment of the dialysate.Outcome:We believe that finding the source of A xylosoxidans contamination is the most important aspect of the overall treatment of the infection.Lessons:Environmental investigation of suspected source contamination is warranted in those with A xylosoxidans infection. Once the diagnosis is made, removal of the Tenckhoff catheter should not be delayed.

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Section: Discussionmentioning

confidence: 99%

Case report

Tsai

2017

Medicine

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“…The patient's gut flora could have been a putative source of infection in this case. Achromobacter is reported in some hepatobiliary and abdominal infections in the form of liver abscesses, dialysis-associated peritonitis, or severe intra abdominal infections [7,10,11], but to the best of our knowledge, infection of a pancreatic pseudocyst has never been reported. The nonfermenting, Gram-negative bacilli that are infrequently isolated in clinical microbiology laboratories face a delay in identification and add to the diagnostic dilemma because of their saprophytic nature.…”

Section: Discussionmentioning

confidence: 99%

Two unique presentations of Achromobacter xylosoxidans infections in clinical settings

Eshwara

Mukhopadhyay

Mohan

et al. 2010

J Infect Dev Ctries

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Two rare and unique infections of Achromobacter xylosoxidans are described. The first case is a novel presentation of acute necrotising pancreatitis leading to a pancreatic pseudocyst, which was treated successfully in an immunocompetent male. The second case describes a local wound infection of metastatic ductal carcinoma of the breast; the patient consequently succumbed from a pre-existing co-morbid condition. Vigilant and efficient microbiological workup and surveillance are needed to diagnose infections by this rare pathogen in clinical settings.

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“…In order to identify all reported and published cases of Achromobacter peritonitis, thorough PubMed (January 1 st , 1966-April 7 th , 2019) literature searches were conducted from March 20 th , 2019 through April 7 th , 2019, and October 10 th , 2019 through October 21 st , 2019 independently by both primary authors. Search terms that were used include "PEG or percutaneous endoscopic gastrostomy tube peritonitis" with no relevant results, "Achromobacter peritonitis" with four relevant results [49][50][51][52], and "Alcaligenes peritonitis" with additional 8 relevant results [12,13,[53][54][55][56][57][58]. Five additional cases were identified through previously published case reports, and extensive search in PubMed with Case Reports in Gastrointestinal Medicine 4 treatment.…”

Section: Peg-tube Associated Complicationsmentioning

confidence: 99%

“…In totality, eighteen previous Achromobacter peritonitis cases were encountered; of which, two were diagnosed as spontaneous peritonitis [12,13] while remaining sixteen cases of peritonitis were associated with peritoneal dialysis [5,8,14,[49][50][51][52][53][54][55][56][57][58][59][60]. No previous cases of PEG tube-associated Achromobacter peritonitis were discovered.…”

Section: Peg-tube Associated Complicationsmentioning

confidence: 99%

First Documented Case of Percutaneous Endoscopic Gastrostomy (PEG) Tube-Associated Bacterial Peritonitis due toAchromobacterSpecies with Literature Review

Tripathi

Koirala

Kato

et al. 2020

Case Reports in Gastrointestinal Medicine

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Introduction. Achromobacter species (spp.) peritonitis has seldom been identified in medical literature. Scarce cases of Achromobacter peritonitis described previously have been correlated with peritoneal dialysis and more sparingly with spontaneous bacterial peritonitis. Achromobacter exhibits intrinsic and acquired resistance, especially in chronic infections, to most antibiotics. This article conducts a literature review of all previously reported Achromobacter spp. peritonitis and describes the first reported case of Achromobacter peritonitis as a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. Discussion. Achromobacter peritonitis as a complication of PEG-tube placement has not been previously reported. In our patients’ case, the recently placed PEG-tube with ascitic fluid leakage was identified as the most plausible infection source. Although a rare bacterial peritonitis pathogen, Achromobacter may be associated with wide antimicrobial resistance and unfavorable outcomes. Conclusion. No current guidelines provide significant guidance on treatment of PEG-tube peritonitis regardless of microbial etiology. Infectious Disease Society of America identifies various broad-spectrum antibiotics targeting nosocomial intra-abdominal coverage; some of these antimicrobial selections (such as cefepime and metronidazole combination) may yet be inadequate for widely resistant Achromobacter spp. Recognizably, the common antibiotics utilized for spontaneous bacterial peritonitis, i.e., third generation cephalosporins and fluoroquinolones, to which Achromobacter is resistant and variably susceptible, respectively, would be extensively insufficient. Piperacillin/tazobactam (P/T) and carbapenem were identified to provide the most reliable coverage in vitro; clinically, 5 out of the 8 patients who received either P/T or a carbapenem, or both, eventually experienced clinical improvement.

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Dialysis-Associated Alcaligenes Xylosoxidans Peritonitis: A Pediatric Case

Cited by 10 publications

References 5 publications

Case report

Case report

Two unique presentations of Achromobacter xylosoxidans infections in clinical settings

First Documented Case of Percutaneous Endoscopic Gastrostomy (PEG) Tube-Associated Bacterial Peritonitis due toAchromobacterSpecies with Literature Review

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