A Rare Case ofRoseomonas gilardiiPeritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis

Abstract

There have been only 5 reported cases of Roseomonas peritonitis in peritoneal dialysis (PD) patients (1-4). Our 61-year-old patient on continuous ambulatory PD (CAPD) presented with asymptomatic, cloudy peritoneal dialysate. Intraperitoneal (IP) cloxacillin and ceftazidime was initiated. Blood test results were as follows: C-reactive protein 168 mg/L, white cells 15.4 × 10 9 /L. Dialysate cell count was 40 cells/ mm 3 , predominantly polymorphs. Dialysate fluid cleared up on day 3, with corresponding negative cell counts. Peritoneal dialysate culture grew Roseomonas gilardii on day 6, resistant to ceftazidime, cefeperazone and piperacillin, and sensitive to amikacin, gentamycin, imipenem, ciprofloxacin, cefepime, and meropenem. Clinical improvement led to continuation of IP ceftazidime and cloxacillin. Two days later, dialysate cell counts rebounded to 180 cells/mm 3. The patient was switched to 2 weeks of IP meropenem and was allowed to go home with improving parameters. She was readmitted on day 22 day for culture-negative PD peritonitis that we suspected was due to inadequately cleared Roseomonas gilardii. Despite treatment with multiple IP antibiotics, the catheter was not salvageable. Ours is the second case of Roseomonas gilardii peritonitis ever reported. Roseomonas is associated with contaminated water source and soil (1,2). Our patient was washing her hands under unhygienic circumstances. Roseomonas peritonitis presents with vague abdominal pain (1-3). Despite 2 weeks of antibiotic treatment, half of the patients in reported cases relapsed within 4 weeks and a third ended up with catheter removal (3,4). Patients with culture-negative peritonitis or with a recent history of Roseomonas infection may benefit from early addition of aminoglycosides, carbapenems, or fluoroquinolones. We therefore suggest IP antibiotic therapy for a minimum of 3 weeks for Roseomonas peritonitis. Relapses must be treated aggressively to avoid refractory peritonitis that will lead to catheter removal and septicemia.

Phylotaxogenomics for the Reappraisal of the Genus Roseomonas With the Creation of Six New Genera

“…It was also found to be associated with immunocompromised patients (Marin et al, 2001). Other reports of bacteremia caused by the Roseomonas species were in vertebral osteomyelitis (Nahass et al, 1995), infected tooth (Diesendorf et al, 2017), endocarditis (Shao et al, 2019), and peritonitis (Malini et al, 2016). However, many reports in case studies suggests that the majority of the patients had underlying diseases, malignancy being the most common factor (Wang et al, 2012;Michon et al, 2014).…”

Roseomonas mucosa-Induced Peritonitis in a Patient Undergoing Continuous Cycler Peritoneal Dialysis: Case Report and Literature Analysis

“…Overall mortality to Roseomonas species was reported by them to be at 1%. Because it is still a rare organism and due to paucity of clinical evidence, it is suggested that treatment duration be stretched to 3 weeks of antibiotics [ 8 ]. Hopefully, this will prevent the change in modality to hemodialysis which is always undesirable to patients.…”