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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 1  |  Page : 181-182
Polymicrobial peritonitis with Leclercia adecarboxylata in a peritoneal dialysis patient


Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey

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Date of Web Publication12-Jan-2017
 

How to cite this article:
Atas DB, Velioglu A, Asicioglu E, Arikan H, Tuglular S, Ozener C. Polymicrobial peritonitis with Leclercia adecarboxylata in a peritoneal dialysis patient. Saudi J Kidney Dis Transpl 2017;28:181-2

How to cite this URL:
Atas DB, Velioglu A, Asicioglu E, Arikan H, Tuglular S, Ozener C. Polymicrobial peritonitis with Leclercia adecarboxylata in a peritoneal dialysis patient. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2017 Aug 24];28:181-2. Available from: http://www.sjkdt.org/text.asp?2017/28/1/181/198272
To the Editor,

Peritoneal dialysis (PD)-related infection is the most common and serious complication of PD patients and the most common reason for switching to hemodialysis. Although most of PD peritonitis episodes are attributed to a single organism, multiple organisms are identified in nearly 10% of peritonitis cases.[1] Leclercia adecarboxylata is a rare cause of PD-related peritonitis. In this report, we describe the case of PD-related polymicrobial peritonitis with L. adecarboxylata.

A 72-year-old female with end-stage renal failure due to chronic glomerulonephritis had been on continuous ambulatory PD for 12 years. She was admitted to the hospital with fever, nausea, vomiting, abdominal pain, and cloudy dialysate. On physical examination, blood pressure was 90/60 mm Hg and body temperature was 38.8°C. Abdominal examination revealed diffuse tenderness with rebounding. The dialysis effluent was turbid. The white cell count of dialysate was above 10,000/μL. Laboratory data showed normal leukocyte number (4.600/μL) with 86% polymorphonuclear cells, high C-reactive protein [135 mg/L (normal: 0-5)], and high procalcitonin [63 ng/mL (normal: 0-0.5)] levels. After hospitalization, blood and peritoneal fluid cultures were taken. Empirical antibiotic treatment with intraperitoneal cefuroxime and oral ciprofloxacin was started. The peritoneal fluid culture yielded Gram-negative rods, later identified as Acinetobacter baumannii, Klebsiella pneumonia, and L. adecarboxylata. Cefuroxime and ciprofloxacin were discontinued, and intravenous imipenem was started according to the antibiogram. After three weeks of therapy, her peritonitis completely resolved. The PD catheter was not removed. There was no relapse of peritonitis upon follow-up.

L. adecarboxylata is a member of Enterobacteriaceae family. It is a ubiquitous, motile, Gram-negative rod, which can be identified with advances in DNA hybridization techniques in clinical specimens.[2] Even though there are a lot of cases of Acinetobacter and Klebsiella peritonitis in the literature, data on Leclercia peritonitis are scant.[2] ,[3] ,[4] Immunosuppression and break in sterility are the major risk factors for Leclercia infections. According to a recently published case report, contamination with raw meat and cassette rupture were found as responsible factors for Leclercia peritonitis in an PD patient.[3] However, we did not find any predisposing factors other than immunosuppression due to uremic milieu in our patient.

The majority of cases which were caused by L. adecarboxylata infection are relatively nonlife threatening and susceptible to most antibiotics. The clinical significance of L. adecarboxylata in polymicrobial infections is unclear and usually can be found as less virulent than coexisting pathogenic bacteria similar in our case.

In conclusion, to the best of our knowledge, this is the first report of polymicrobial peritonitis with L. adecarboxylata. However, we do not know the exact epidemiology of L. adecarboxylata infections because of the paucity of reports. Usage of appropriate microbiologic techniques might increase the prevalence of rare microorganisms such as L. adecarboxylata as a cause of peritonitis in patients with PD.

Conflict of interest: None declared.

 
   References Top

1.
Kim GC, Korbet SM. Polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 2000;36:1000-8.  Back to cited text no. 1
    
2.
Fattal O, Deville JG. Leclercia adecarboxylata peritonitis in a child receiving chronic peritoneal dialysis. Pediatr Nephrol 2000;15:186-7.  Back to cited text no. 2
    
3.
Chao CT, Hung PH, Huang JW, Tsai HB. Cycler cassette rupture with Leclercia adecarboxylata peritoneal dialysis peritonitis. Perit Dial Int 2014;34:131-2.  Back to cited text no. 3
    
4.
Rodríguez JA, Sánchez FJ, Gutiérrez N, García JE, García-Rodríguez JA. Bacterial peritonitis due to Leclercia adecarboxylata in a patient undergoing peritoneal dialysis. Enferm Infecc Microbiol Clin 2001;19:237-8.  Back to cited text no. 4
    

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Correspondence Address:
Arzu Velioglu
Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul
Turkey
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DOI: 10.4103/1319-2442.198272

PMID: 28098124

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