Burkholderia cepacia—A rare but important cause of refractory peritonitis in patients with continuous ambulatory peritoneal dialysis: A case report and literature review

Abstract

Refractory peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) caused by Burkholderia cepacia is very rare. Herein, we describe a case of B. cepacia-related refractory peritonitis and present a literature review of similar cases. A 62-year-old male patient presented with diffuse abdominal pain, bloating, and turbid peritoneal effluent. Initial dialysis effluent culture was negative for any microorganism. The patient initially underwent treatment with piperacillinsulbactam. The second dialysis effluent culture was positive for gram stain and later tested positive for B. cepacia. Peritoneal dialysis (PD) catheter removal was recommended, and the patient agreed to undergo regular hemodialysis. To the best of our knowledge, this is the first case of B. cepacia-related refractory peritonitis in a patient undergoing CAPD with no history of a recent hospitalization. B. cepacia infections can result in death in some areas. Therefore, timely catheter removal and switching treatment to hemodialysis is recommended for patients with B. cepacia-related refractory peritonitis. | INTRODUCTIONPeritonitis is a common and serious infection-related complication in patients undergoing peritoneal dialysis (PD) and a cause of mortality in about 16% of all patients receiving PD. 1 Previous studies have shown that gram-positive bacteria (mainly coagulase-negative staphylococcus, enterococcus species, and streptococcal species) are the most common bacteria causing peritonitis. Gram-negative bacteria (mainly Corynebacterium and Pseudomonas) account for 15%-35%. 2Burkholderia cepacia is a gram-negative bacteria that has become increasingly recognized as an important nosocomial pathogen responsible for hospital outbreaks. However, B. cepacia-related peritonitis in CAPD is a very rare occurrence in clinical practice. One possible reason is that B. cepacia is often misdiagnosed as non-lactose-fermenting bacillus, especially of Pseudomonas spp. in most developing countries. 3 To the best of our knowledge, this is the first report of a patient undergoing CAPD who developed refractory peritonitis due to B. cepacia infection with no history of recent hospitalization.

Peritonitis caused by Listeria monocytogenes and Burkholderia cepacia in a patient on peritoneal dialysis: a case report

“…Most previous cases of B. cepacia infection were a part of cluster outbreaks caused by contaminated aqueous chlorhexidine in dialysis wards ( 9 , 10 ). Fever, abdominal pain, turbid ascites, abdominal distension, nausea, and vomiting are common presentations in the few available case reports ( 5 , 6 ), along with treatment methods ranging from only antibiotic therapy to the surgical removal of the PD catheter ( 5 ). However, comprehensive evidence for an effective treatment method is limited owing to the small number of cases.…”

Delayed Composite Mesh Infection: Can Burkholderia Cepacia be Incriminated?

“…There have also been reports documenting BCC as being responsible for endocarditis in drug addicts or patients with prosthetic heart valves [26], eye infections following surgery [27] and infections or abscesses of the central nervous system [28]. BCC is also rarely responsible for refractory peritonitis in patients undergoing continuous ambulatory peritoneal dialysis [29,30]. Some cases of splenic and hepatic abcesses were also reported [31,32].…”