Two Cases of Peritonitis Caused byKocuria marinain Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Abstract

Kocuria spp. are members of the Micrococcaceae family that are frequently found in the environment and on human skin. Few human infections have been reported. We describe what appear to be the first two cases of Kocuria marina peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. CASE REPORTS Case 1.A 57-year-old man was admitted to the emergency department because of turbid dialysis effluent for 1 day. He had end-stage renal disease as a result of diabetic nephropathy and had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years. Upon physical examination, he was afebrile, with a normal-appearing catheter exit site. However, the peritoneal dialysate fluid was straw colored and cloudy, with a total leukocyte count of 0.78 ϫ 10 9 leukocytes/ liter and a neutrophil count of 90%. No microorganisms were seen on a Gram stain. In the peripheral blood, the hemoglobin concentration was 10.1 g/dl, the white blood cell (WBC) count was 7.40 ϫ 10 9 cells/liter, and the platelet count was 171 ϫ 10 9 platelets/liter. The C-reactive protein concentration was 2.76 mg/dl (reference concentration, Ͻ0.5 mg/dl), and the serum urea and creatinine concentrations were 53 mg/dl and 11.2 mg/dl, respectively. Intraperitoneal administration of netilmicin and narrow-spectrum cephalosporin (ceftezole) was started for empirical treatment of CAPD peritonitis, which was changed to intraperitoneal ceftazidime and clindamycin when there was no response. Culture of the dialysate yielded a pure culture of grampositive cocci in pairs or clusters (strain M07-0128). After 48 h of incubation at 35°C in 5% CO 2 on sheep blood agar, the 1-to 2-mm colonies were nonhemolytic and yellow. The isolate was identified as Kocuria varians/Kocuria kristinae with a 50.28%/49.72% probability, respectively, by a Vitek 2 system (bioMérieux, St. Louis, MO) and as K. kristinae (code number 6714014) with a 99.3% probability by an API Staph system (bioMérieux, Marcy l'Etoile, France). We performed 16S rRNA gene sequencing as previously described (5) and compared the obtained sequence with sequences similar to those of the type strains using BLAST and EzTaxon (4). The result showed 99.86% homology with Kocuria marina; the second closest match was Kocuria carniphila, with 98.30% homology. This isolate was finally identified as K. marina by 16S rRNA gene sequence analysis. In spite of the start of administration of intravenous vancomycin on day 10, the response remained unsatisfactory. The Tenckhoff catheter in his abdomen was removed on day 17, and he was switched to hemodialysis with the placement of an arteriovenous shunt. The patient improved with antibiotic therapy for 7 days after catheter removal and was discharged.We performed antimicrobial susceptibility testing on the isolate using the agar dilution method, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines for Staphylococcus (4a). The isolate was susceptible to penicillin, ampicillin, ampicillin-sulbactam, gentamicin, cephalothin (cefaloti...

Persistent Bloodstream Infection with Kocuria rhizophila Related to a Damaged Central Catheter

“…Another member of the genus, K. kristinae, has also been reported to cause a catheter-related bacteremia in patients with ovarian cancer (3) or acute cholecystitis (14). In 2009, two cases of peritonitis caused by K. marina were reported by Lee et al (12). More recently, in 2010, Lai et al (11) reported catheter-related bacteremia and infective endocarditis caused by Kocuria sp., whereas Tsai et al (27) reported a K. varians infection associated with brain abscess.…”

Kocuria dacryocystitis infection, caused by kocuria ocularis sp. Nov.

“…Indeed, it has been reported that Kocuria can cause bacteraemia in chronically ill patients with malignancies or in immunosuppressed states (Basaglia et al, 2002;Martinaud et al, 2008). Kocuria infection has been linked to cases of peritonitis associated with peritoneal dialysis (Altuntas et al, 2004;Lee et al, 2009;Meletis et al, 2012), acute cholecystitis (Ma et al, 2005), catheter-related bacteraemia (Dunn et al, 2011;Lai et al, 2011;Moissenet et al, 2012), infective endocarditis (Lai et al, 2011) and brain abscesses (Tsai et al, 2010). Here, we describe the first known case of Kocuria dacryocystitis in an immunocompetent patient.…”

Kocuria Species Peritonitis: Although Rare, we Have to Care

“…One patient experienced 3 episodes of relapsing peritonitis attributable to K. varians; another had 2 episodes of relapsing peritonitis attributable to the same Kocuria species. In total, 9 PD patients with end-stage renal disease were reported to experience peritonitis caused by Kocuria species (4,5,(8)(9)(10)(11)(12)(13). In all the Kocuria peritonitis episodes, no ultrafiltration problems were reported.…”

“…Nevertheless, the patient who experienced 3 relapsing peritonitis episodes with K. varians received IP cefazolin for 10 days for the first episode, IP cefazolin for 7 days JANUARY 2015 -VOL. 35, NO.1 PDI after peritonitis relapse, and IP cefazolin for 14 days after the second relapse, which is the formal suggested regimen (4). Recommendations for avoidance of Kocuriaspecies peritonitis follows the general consensus guidelines for the prevention of catheter-related infections and peritonitis in pediatric patients receiving PD (7).…”