Achromobacter xylosoxidans Relapsing Peritonitis and Streptococcus suis Peritonitis in Peritoneal Dialysis Patients: A Report of Two Cases

Abstract

Peritonitis is considered to be the most common complication of peritoneal dialysis (PD). It is usually caused by Gram positive Staphylococcus epidermidis. Achromobacter xylosoxidans (A. xylosoxidans) and Streptococcus suis (S. suis) are rare pathogens, but there is emerging evidence that they may be also responsible for PD related peritonitis. We described 2 cases of rare peritonitis treated in our center. In our opinion this is the first described case of PD related peritonitis caused by Streptococcus suis.

A Rare Cause of Infection, Achromobacter xylosoxidans

“…Periton diyaliz hastalarında A. xylosoxidans'ın neden olduğu 12 peritonit olgusu bildirilmiştir. Bu çalışmalar kronik böbrek yetmezliği olan hastaların immünsüpresyon durumlarının önemli bir risk faktörü olduğunu göstermiştir [13] . A. xylosoxidans'ın periton diyaliz kateterlerinde biyofilm oluşturabileceği, bu nedenle bu tür infeksiyonlarda kateterin çıkarılması önerilmektedir [13] .…”

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

“…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.…”

“…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.…”

“…Glucose containing peritoneal dialysate and aqueous environment foster Achromobacter proliferation and associated infection. Moreover, Achromobacter colonies may have the ability to surround the PD catheter with biofilm [14,52,61,62]. Bacteria in biofilms in vivo are significantly less susceptible to antimicrobials identified to have adequate coverage through laboratory testing in vitro [43].…”

“…In addition to appropriate antimicrobial therapy, case seventeen also highlights the importance of timely removal of peritoneal dialysis catheter. Donderski et al [52] report multiple peritonitis relapse associated readmissions; fortunately, no further episodes were reported following PD catheter removal and a course of adequate antimicrobial regimen. us, multiple case studies highlight the importance of timely removal of Achromobacter infected PD catheters; Donderski et al [52] identify catheter removal as the most preferred treatment extensively insufficient.…”