Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans
© Kahveci et al; licensee BioMed Central Ltd. 2011
Received: 24 January 2011
Accepted: 10 April 2011
Published: 10 April 2011
An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients.
The most common pathogens causing peritonitis in peritoneal dialysis (PD) patients are gram positive organisms, Staphylococcus epidermidis and Staphylococcus aureus. Gram negative organisms and fungi are less common causes. Environmental organisms are rarely implicated in patients with peritonitis. With the following report we describe two peritonitis episodes in successive years caused by two unusual microorganism: Alcaligenes faecalis and Pantoea agglomerans.
Alcaligenes faecalis and Pantoea agglomerans are classified as environmental bacteria and plant pathogens and are rarely reported as being responsible for clinically significant infections in human. Alcaligenes faecalis is a gram negative oxidase positive rod with peritrichous flagella which exists in soil and water. It is also found in the alimentary tract as a harmless saprophyte in 5-19% of the human population. Systemic infection with this organism is very uncommon. To our knowledge, this is the second report of a PD patient with Alcaligenes faecalis peritonitis. This patient recovered by antimicrobial therapy alone and did not require catheter removal similar to previous patient reported by Kavuncuoglu et al. . However another species of Alcaligenes, Alcaligenes xylosoxidans has been reported to cause peritonitis in PD patients previously . The majority of these patients required catheter removal because of resistance to most antibiotic therapies. Even though Alcaligenes faecalis is presumed to be resistant to antibiotics, as in our isolate, our case emphasizes the importance of sensitivity testing when it is isolated.
Cases of Peritoneal Dialysis (PD) Associated Peritonitis with Pantoae Agglomerans
Type of PD
Teeting to catheter
Cured, catheter replaced new one
In conclusion, although these organisms are rarely fatal and are commonly considered to be contaminants they can cause symptomatic peritonitis, which in turn leads to death. It is therefore very important to view these organisms as pathogens rather than contaminants when isolated in patients with peritonitis. Microbiological antibiotic testing should always be requested from the laboratory and patients should be treated accordingly. When there is no improvement with antibiotic therapy, early removal of the peritoneal catheter should be planned since these infections may prove fatal.
Written informed consent was obtained from the patient's daughter for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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