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Relapsing Bacillus cereus peritonitis in a patient treated with continuous ambulatory peritoneal dialysis.

ABSTRACT: INTRODUCTION:Peritonitis is a severe complication of peritoneal dialysis (PD) due to associated morbidity and mortality. Although Bacillus cereus is mostly considered as a contaminant, its role as a causative agent in a few cases of PD peritonitis has been documented. Peritonitis due to B. cereus has been associated with high rates of catheter removal and resistance to beta-lactam antibiotics. CASE PRESENTATION:A case of relapsing peritonitis caused by B. cereus in a 69-year-old man with end-stage renal disease on continuous ambulatory PD for 3?years is described. B. cereus was recovered from the patient's peritoneal fluid and was identified by phenotypic and molecular methods. The patient was treated, according to the susceptibility test, with tobramycin for 14 days. Cultures became sterile and the patient was discharged from hospital. Three days after discharge, the patient reported recurrence of abdominal pain and a new antibiotic regimen based on the previous culture results was initiated consisting of vancomycin and ciprofloxacin. The presence of B. cereus in the peritoneal fluid was confirmed, whereas repeated cultures for the next 15 days were positive. All B. cereus isolates produced biofilm. On day 16, the PD catheter was removed and the patient was transferred to haemodialysis. A review of previously reported cases is also presented. CONCLUSION:Since peritonitis is the most common cause of transition to haemodialysis, isolation of B. cereus from PD patients, even though rare, should not be considered as a contaminant. An appropriate antibiotic regimen and, whenever necessary, catheter removal should be applied.

SUBMITTER: Spiliopoulou A

PROVIDER: S-EPMC5415935 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Relapsing <i>Bacillus cereus</i> peritonitis in a patient treated with continuous ambulatory peritoneal dialysis.

Spiliopoulou Anastasia A Papachristou Evangelos E Foka Antigoni A Kolonitsiou Fevronia F Anastassiou Evangelos D ED Goumenos Dimitrios S DS Spiliopoulou Iris I

JMM case reports 20141201 4

<h4>Introduction</h4>Peritonitis is a severe complication of peritoneal dialysis (PD) due to associated morbidity and mortality. Although <i>Bacillus cereus</i> is mostly considered as a contaminant, its role as a causative agent in a few cases of PD peritonitis has been documented. Peritonitis due to <i>B</i>. <i>cereus</i> has been associated with high rates of catheter removal and resistance to beta-lactam antibiotics.<h4>Case presentation</h4>A case of relapsing peritonitis caused by <i>B. c ...[more]

PMID: 28663812

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Project description:Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to take interventions to reduce peritonitis incidence and improve clinical outcomes.

Dataset Information

Relapsing Bacillus cereus peritonitis in a patient treated with continuous ambulatory peritoneal dialysis.

Publications

Relapsing <i>Bacillus cereus</i> peritonitis in a patient treated with continuous ambulatory peritoneal dialysis.

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