Relapsing and refractory peritoneal dialysis peritonitis caused by Corynebacterium amycolatum.
Bacterial biofilm
Corynebacterium amycolatum
PD peritonitis
Pediatric peritoneal dialysis
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
16
09
2022
accepted:
24
10
2022
revised:
24
10
2022
medline:
31
3
2023
pubmed:
10
11
2022
entrez:
9
11
2022
Statut:
ppublish
Résumé
Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade. We present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation. C. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.
Sections du résumé
BACKGROUND
Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade.
CASE-DIAGNOSIS/TREATMENT
We present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation.
CONCLUSIONS
C. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.
Identifiants
pubmed: 36352270
doi: 10.1007/s00467-022-05801-0
pii: 10.1007/s00467-022-05801-0
pmc: PMC10060281
doi:
Substances chimiques
Anti-Bacterial Agents
0
Dialysis Solutions
0
Glycopeptides
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1687-1692Informations de copyright
© 2022. The Author(s).
Références
Nephrol Dial Transplant. 2005 Dec;20(12):2793-6
pubmed: 16204300
Pol J Microbiol. 2018;67(4):431-440
pubmed: 30550229
Perit Dial Int. 2012 Jun;32 Suppl 2:S32-86
pubmed: 22851742
Perit Dial Int. 2017 Nov-Dec;37(6):619-626
pubmed: 28698253
Braz J Infect Dis. 2018 Jul - Aug;22(4):347-351
pubmed: 30102894
Perit Dial Int. 2022 Mar;42(2):110-153
pubmed: 35264029
J Vasc Access. 2021 Mar;22(2):261-265
pubmed: 32605474
Infez Med. 2004 Jun;12(2):126-31
pubmed: 15316299
Clin Nephrol. 2005 Mar;63(3):241-2
pubmed: 15786829
J Microbiol Methods. 2017 Nov;142:33-35
pubmed: 28888870
Clin J Am Soc Nephrol. 2016 Sep 7;11(9):1590-6
pubmed: 27340282
Lett Appl Microbiol. 2018 Jun;66(6):472-483
pubmed: 29573441