Abstract: PUB140
Challenges of Treating Stenotrophomonas maltophilia Peritonitis in a Peritoneal Dialysis Patient With Suprapubic Catheter
Session Information
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Hongalgi, Krishnakumar D., Albany Medical Center, Albany, New York, United States
- Abid, Sidrah, Albany Medical Center, Albany, New York, United States
- Beers, Kelly H., Albany Medical Center, Albany, New York, United States
- Mehta, Swati, Albany Medical Center, Albany, New York, United States
Introduction
Peritoneal dialysis (PD) is a preferred home modality of treatment for end stage kidney disease (ESKD). Peritonitis is the most feared complication associated with long term PD and is associated with increased morbidity and mortality. We report a rare case of stenotrophomonas maltophilia peritonitis in a patient with chronic suprapubic catheter.
Case Description
59-year-old male with ESKD with history of suprapubic catheter had beta hemolytic strep peritonitis followed by another episode of coagulase negative staph peritonitis which were treated outpatient with intraperitoneal (IP) antibiotics. He was admitted to the hospital later with another episode of abdominal pain and cloudy peritoneal effluent. He was hemodynamically stable, afebrile and had mild leukocytosis without left shift. Empiric treatment with IP vancomycin and ceftazidime was started. Peritoneal culture grew >100,000 colonies of stenotrophomonas maltophilia resistant to ceftazidime, sensitive to levofloxacin and trimethoprim/sulfamethoxazole. Ceftazidime was discontinued and patient was started on oral levofloxacin and trimethoprim/sulfamethoxazole with plan for 21 days of treatment. PD catheter was left in-situ and PD was continued without interruption. Patient improved clinically and was discharged with outpatient follow up. Levofloxacin was eventually discontinued after 2 weeks due to prolonged QT interval.
Discussion
PD has been established as a safe modality of kidney replacement therapy empowering patients in selfcare. PD catheter associated peritonitis is common cause of treatment failure as it can result in loss of PD catheter. Stenotrophomonas maltophilia is a rare cause of peritonitis with reported loss of PD catheter in over half of cases. Treating peritonitis in a patient with suprapubic catheters is challenging. Our patient was successfully treated with levofloxacin and trimethoprim/sulfamethoxazole without necessitating the removal of his PD catheter.