Unusual cases of peritonitis: A case series of five patients

Abstract

Introduction: Peritonitis is a complication in patients on peritoneal dialysis that frequently results from touch contamination. Most cases of peritoneal dialysis-related peritonitis are caused by skin organisms. Herein, we are presenting a series of peritonitis cases with unusual organisms in a single home dialysis center at an academic hospital in New York City. Methods: The records of five patients with an unusual cause of peritonitis were reviewed by a clinician. We have chronologically tabulated the cell count of the dialysate, microbiologic cultures, and antibiotics received by each patient. Additionally, both a table and figure detail the microbiologic organisms that our dialysis unit encountered over the 3-year period concurrent with the infections reported. Results: The first patient presented with refractory polymicrobial peritonitis due to a liver abscess. Another patient presented with diverticulitis and developed enteric peritonitis with various organisms. The following patient had peritonitis in the setting of bowel pathologies and from Rhizobium after exposure to plants. The next patient developed Pasteurella peritonitis from his cat. The final patient developed multiple episodes of peritonitis from organisms including flora native to soil and water. Conclusion: These uncommon cases of peritonitis with unusual circumstances bring awareness to various elements that can lead to peritonitis. 1 | INTRODUCTION Peritoneal dialysis (PD) is the dialysis modality used by about 10% of end-stage kidney disease (ESKD) patients in the United States, 1 and peritonitis is a common complication. Most peritonitis cases develop through touch contamination during PD connections and are usually caused by common skin organisms. 2 We report here five ESKD patients on maintenance PD who developed peritonitis due to uncommon organisms. | METHODSThe records of five PD patients with an unusual cause of peritonitis in a clinic in New York City were reviewed by a clinician. The clinical course for each patient is described, and then, the implications for these organisms are detailed. The cases described span widely between 2010 and 2021. We have chronologically tabulated the cell count of the dialysate, microbiologic cultures, and antibiotics received among each patient. Additionally, a table details the various microbiologic organisms that our dialysis unit encountered during the period of 1 January 2018 to 31 December 2021. Finally, a pie chart has been included to better conceptualize the prevalence of various microbiologic organisms in our dialysis unit.