Abstract: FR-PO484
B Cereus! A Case of Peritonitis
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Arif, Hamza, Ohio Valley Nephrology Associates, Owensboro, Kentucky, United States
- Murtaza, Ibraheem, University of Kentucky, Lexington, Kentucky, United States
- Iftikhar, Hassaan, Ohio Valley Nephrology Associates, Owensboro, Kentucky, United States
- Saleem, Maryam, Ohio Valley Nephrology Associates, Owensboro, Kentucky, United States
Introduction
Peritonitis is a commonly encountered complication of peritoneal dialysis (PD), often associated with poor dialysis hygiene and constipation. Most common etiologies include Gram-negative rods and Gram-positive cocci, particularly Staphylococcus aureus. Bacillus cereus has been rarely identified as a causative organism of peritonitis.
Case Description
A 59-year-old gentleman with end stage kidney disease on continuous ambulatory peritoneal dialysis (CAPD) for 3 years presented to the dialysis clinic with abdominal pain and cloudy effluent. He had prior episodes of recurrent peritonitis from coagulase-negative Staphylococci (CONS) requring removal of the PD catheter but was restarted on CAPD 3 months after and did not have any peritonitis episode for 2 years.
Initial cell count revealed absolute nucleated cell count of 491 and he was empirically started on intraperitoneal (IP) vancomycin and ceftazidime as well as fluconazole for fungal prophylaxis. Gram stain results 2 days later showed gram positive bacilli. After 4 days, PD cultures revealed Bacillus species (not anthracis). Sample was sent for further testing and finally identified Bacillus cereus with sensitivity to vancomycin 13 days after initial culture date.
The patient initially received a 2-week course of IP vancomycin which was extended to 4 weeks given concern for the formation of spores with Bacillus cereus. His symptoms initially resolved, but 2 weeks after finishing the antibitics course, he reported abdominal pain again. PD cultures again revealed Bacillus cereus and he was initiated on another 3-week course of IP vancomycin.
Discussion
Bacillus cereus are gram-positive, aerobic, spore-forming, rod-shaped bacteria. They are usually described in cases related to food poisoning. Literature review indicates rare reports involving peritonitis from this organism. Prior descriptions of peritonitis with Bacillus cereus included relapsing, recurrent peritonitis eventually requiring removal of the PD catheter.
The patient's history of recurrent peritonitis due to CONS which required removal of the CAPD catheter two years earlier, along with this new Bacillus cereus peritonitis, indicate the importance of maintaining hygiene with each treatment and retraining in patients with peritonitis.