A Patient Required Peritoneal Catheter Removal Caused by Peritoneal Dialysis-related Peritonitis due to Gram-negative Rod-like Pseudomonas aeruginosa During Antibiotic Therapy for Enterococcus faecalis
Journal of Nippon Medical School
In patients undergoing peritoneal dialysis (PD), peritonitis is one of the most common complications, and causes PD catheter removal, permanent transfer to hemodialysis, and potentially death. Therefore, the prediction and prevention of PD-related peritonitis are extremely important. In 2016, the International Society for Peritoneal Dialysis published guidelines for peritonitis in patients undergoing PD; these guidelines cover most cases of PD-related peritonitis caused by various bacteria.
... rious bacteria. Furthermore, the guidelines clearly propose the indications for catheter removal. However, difficulties often arise when deciding on the best time for catheter removal. Peritonitis with the identification of multiple enteric organisms from a culture of dialysis effluent may be caused by intra-abdominal pathology, and if a patient with peritonitis has such pathology, the mortality rate is high, and the catheter removal is considered in that case. In this report, we describe a case in which, during antibiotic therapy for PD-related peritonitis due to Enterococcus faecalis alone, the patient suffered another occurrence of peritonitis due to newly revealed Gram-negative rod-like Pseudomonas aeruginosa. He required catheter removal due to the peritonitis being suspected of relapsing. Although so further investigations are required, it is possible that early catheter removal is effective in cases in which another organism is newly detected during antibiotic therapy for PD-related peritonitis caused by a different responsible organism not meeting the definition of refractory peritonitis.