Successful Treatment of Peritoneal Dialysis Catheter-Related Polymicrobial Peritonitis Involving Clostridium difficile

Bharti, Sheena; Malhotra, Prashant; Juretschko, Stefan

doi:10.1128/jcm.02021-15

Cited by 4 publications

(3 citation statements)

References 13 publications

(20 reference statements)

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“…While there are single case reports of PD-related peritonitis due to Clostridum difficile or Clostridium perfrigens (11,12), to the best of our knowledge, this is the first report of PD-related peritonitis due to C. ramosum.…”

Section: Discussionmentioning

confidence: 84%

Clostridium Ramosum—A Rare Cause of Peritoneal Dialysis-Related Peritonitis

2018

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Section: Discussionmentioning

confidence: 84%

Clostridium Ramosum—A Rare Cause of Peritoneal Dialysis-Related Peritonitis

2018

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“…Unfortunately, these may worsen CDI. A strategy that allows for appropriate antimicrobial administration without potential for worsening CDI may improve patient care in this population [11].…”

Section: Discussionmentioning

confidence: 99%

“…Together, these could lead to inappropriate early management, prolonged disease course, and adverse patient outcomes [10]. A strategy that allows greater vigilance for diagnosing CDI, and appropriate antimicrobial administration without potential for worsening CDI may improve patient care in this population [11]. We present a potentially novel strategy for the empiric management of PD peritonitis through discussion of two such cases who received care in our medical center within a 12-month period.…”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

et al. 2020

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Background: Initial presentation of peritoneal dialysis associated infectious peritonitis can be clinically indistinguishable from Clostridioides difficile infection (CDI) and both may demonstrate a cloudy dialysate. Empiric treatment of the former entails use of 3rd-generation cephalosporins, which could worsen CDI. We present a logical management approach of this clinical scenario providing examples of two cases with CDI associated peritonitis of varying severity where the initial picture was concerning for peritonitis and treatment for CDI resulted in successful cure. Case presentation: A 73-year-old male with ESRD managed with PD presented with fever, abdominal pain, leukocytosis and significant diarrhea. Cell count of the peritoneal dialysis effluent revealed 1050 WBCs/mm 3 with 71% neutrophils. C. difficile PCR on the stool was positive. Patient was started on intra-peritoneal (IP) cefepime and vancomycin for treatment of the peritonitis and intravenous (IV) metronidazole and oral vancomycin for treatment of the C. difficile colitis but worsened. PD fluid culture showed no growth. He responded well to IV tigecycline, oral vancomycin and vancomycin enemas. Similarly, a 55-year-old male with ESRD with PD developed acute diarrhea and on the third day noted a cloudy effluent from his dialysis catheter. PD fluid analysis showed 1450 WBCs/mm 3 with 49% neutrophils. IP cefepime and vancomycin were initiated. CT of the abdomen showed rectosigmoid colitis. C. difficile PCR on the stool was positive. IP cefepime and vancomycin were promptly discontinued. Treatment with oral vancomycin 125 mg every six hours and IV Tigecycline was initiated. PD fluid culture produced no growth. PD catheter was retained. Conclusions: In patients presenting with diarrhea with risk factors for CDI, traditional empiric treatment of PD peritonitis may need to be reexamined as they could have detrimental effects on CDI course and patient outcomes.

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Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

Herberts

Hicks

Sohail³

et al. 2018

BMJ Case Reports

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A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

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Successful Treatment of Peritoneal Dialysis Catheter-Related Polymicrobial Peritonitis Involving Clostridium difficile

Cited by 4 publications

References 13 publications

Clostridium Ramosum—A Rare Cause of Peritoneal Dialysis-Related Peritonitis

Clostridium Ramosum—A Rare Cause of Peritoneal Dialysis-Related Peritonitis

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

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