Peritonitis from Facultative Anaerobic Gram-Negative Bacilli Likely due to Translocation of Bacteria from Gut in a Patient Undergoing Peritoneal Dialysis

Abstract

The peritonitis caused by gram-negative organisms is a serious complication encountered in patients undergoing peritoneal dialysis, often causing high morbidity and mortality. There has been recognition of peritonitis caused by uncommon organisms because of improved microbiological detection techniques. The healthcare providers involved in the management of these patients should be very vigilant. We report a rare case of peritonitis caused bycA 42-year-old male on peritoneal dialysis for five years presented with abdominal pain and cloudy effluent. The peritoneal fluid analysis was consistent with peritonitis, and peritoneal fluid culture grew Citrobacter freundii. The patient was treated with two courses of double antibiotic coverage with intraperitoneal ceftazidime and oral ciprofloxacin, which failed to resolve the infection and hence resulted in the removal the peritoneal dialysis catheter and dialysis modality change.

Comparison of risk of peritoneal dialysis-associated peritonitis between roxadustat and recombinant human erythropoietin in peritoneal dialysis patients: a retrospective comparative cohort study

“…Moreover, HIF-2α deficiency impairs the ability of macrophages to respond and migrate to sites of inflammation in vivo ( 34 ). In addition, constipation has been reported to be associated with peritonitis in PD patients ( 35 ) due to the translocation of bacteria from the gut ( 36 , 37 ). The intestinal epithelium is in a continuous state of transient oxygen deprivation ( 38 ).…”

Intercellular communication in peritoneal dialysis

“…Enterobacteriaceae and Pseudomonas are also increased in fecal samples of PD patients, which accounts for a bacteriological cause of peritonitis or severe peritonitis ( Ren et al, 2020 ). Recent studies state that translocation of gut bacteria, such as anaerobic Gram-positive cocci ( Enterococcus ) ( Adapa et al, 2019 ) and facultative anaerobe Gram-negative bacilli ( Citrobacter freundii ) ( Adapa et al, 2020 ), directly or indirectly results in peritonitis in PD. Trimethylamine-N-oxide (TMAO), a metabolite produced by the gut microbiota, might be a risk factor for peritonitis in PD patients ( Zhang et al, 2022 ).…”