Abstract: PO0979
Micrococcus Peritonitis Complicating Peritoneal Dialysis
Session Information
- Peritoneal Dialysis
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Li, Martin L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Shah, Ankur, Rhode Island Hospital, Providence, Rhode Island, United States
Introduction
Peritonitis is one of the most common and consequential complications of peritoneal dialysis. Micrococcus sp are catalase-positive, coagulase-negative, gram-positive cocci that are increasingly recognized as opportunistic pathogens in patients with immunocompromise or indwelling catheters. These bacteria have been rarely implicated as causative in peritonitis. We present a case of peritonitis due to Micrococcus sp and review the pertinent literature.
Case Description
A 55-year-old female with history of ESKD due to diabetic kidney disease, CAD s/p CABG, and hypertension presented with a 1 day history of cloudy effluent. She had no prior peritonitis episodes. Vital signs were stable and exam was notable for a soft non-tender abdomen and clean and dry exit site without discharge or granulation tissue. Effluent was hazy in appearance. Administration of empiric vancomycin and gentamicin was initiated, resulting in clearing of effluent within 48 hours. Effluent leukocyte count was 204 cells/uL with 58% neutrophils. Intraperitoneal vancomycin was continued for 3 weeks due to intermittent low troughs. Further history revealed intermittent mask use while performing exchanges. After completion of treatment, there was a complete resolution of symptoms and peritoneal cell count. Cell count and culture were repeated 1 month later during evaluation of abdominal pain eventually found to be due to constipation. Leukocyte count was 6 cells/uL but culture again grew Micrococcus sp. After culture was repeated once more and remained persistently positive, repeat treatment to eradicate was attempted with 2 more weeks IP vancomycin but culture remained positive. Eventually the catheter was removed due to a change in living situation. After 5 months of hemodialysis, peritoneal catheter was replaced and the patient was restarted on peritoneal dialysis, after which time she has not had any peritonitis episodes.
Discussion
We present the 10th case of Micrococcus sp. Peritonitis in a peritoneal dialysis patient. Prior cases have been associated with breaks in technique and have shown a pattern of recurrence with resultant technique failure being very common. Attempted treatments have included vancomycin, cefazolin, ceftazidime, and teicoplanin. In the prior 9 published cases, 4 resulted in technique failure. This case and review of the literature can serve to inform future occurrences.