We report here four cases of continuous ambulatory peritoneal dialysis-related peritonitis caused by three different species of Gordonia. The portal of entry was likely through Tenckhoff catheters. 16S rRNA and secA1 gene sequencing are so far the most reliable methods for the accurate identification of Gordonia species.
Gordonia species are Gram-positive weakly acid-fast coryneform bacteria. Although Gordonia species have been implicated in a variety of infections, only seven cases of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis caused by Gordonia species have been described (1-4). Furthermore, the methods used for identifying these seven Gordonia isolates were not mentioned in five cases (2, 4), and the accuracy of the identifications could not be ascertained. In this article, we described four cases of CAPD-related peritonitis caused by three different species of Gordonia confirmed by 16S rRNA and secA1 gene sequencing.Clinical specimens were collected and handled according to standard protocols, and the clinical data were collected by analyzing the patients' hospital records. Phenotypic identification was performed using standard conventional biochemical methods and the API Coryne system (bioMérieux, France). All tests were performed in triplicate. The MICs were determined using Etests (bioMérieux), according to the standards of the Clinical and Laboratory Standards Institute (CLSI) (5), with Escherichia coli strain ATCC 25922 and Pseudomonas aeruginosa strain ATCC 27853 as controls; the results were compared with the CLSI MIC interpretive standards for Staphylococcus spp. and Streptococcus pneumoniae (6) for evaluation. Bacterial DNA extraction, PCR amplification, and DNA sequencing of the 16S rRNA and secA1 genes were performed according to our previous publication (7), except for the primer pairs used (G268F/G1096R [8] for the 16S rRNA gene and SecA1-f/SecA1-r [9] for the secA1 gene). Comparative sequence identity analysis and phylogenetic analysis using the maximum likelihood method were performed according to our previous publication (10), except that MEGA 6.06 (11) was used instead. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was performed according to our previous publication (12), and the protein profiles obtained were processed and analyzed using MALDI Biotyper 3.1 (Bruker Daltonics, Germany) for the generation of the hierarchical cluster analysis (HCA) dendrogram and for identification. Case 1. A 65-year-old Chinese man was admitted for cloudy dialysis effluent for 1 day. He had end-stage renal failure (ESRF) of unknown etiology and had been undergoing CAPD for 7 years. He was afebrile but had turbid dialysis effluent. The total leukocyte count of the dialysis fluid was 930/mm 3 , with neutrophil predominance. A Gram smear of the dialysis effluent after centrifugation revealed numerous leukocytes without any organisms. Empirical intraperitoneal (i.p.) cefazolin and gentamicin therapies were started. As the clinical condition of...