Keywords
Phytobacter peritonitis
Phytobacter ursingii
Phytobacter ursingii infection
refractory Phytobacter peritonitis
refractory PD peritonitis
Categories
Abstract
We report a case of refractory peritonitis in a middle-aged man with end-stage kidney disease on continuous ambulatory peritoneal dialysis (CAPD). The patient had prior episodes of methicillin-resistant Staphylococcus epidermidis peritonitis in July and October 2024, both successfully treated with intraperitoneal (IP) vancomycin. In November 2024, he presented with cloudy dialysate, abdominal pain, and diarrhoea, fulfilling ISPD criteria for peritonitis. Risk factors included poor glycaemic control, hypokalaemia, and recent hospitalisation. Empirical IP vancomycin and ceftazidime were initiated. Peritoneal fluid culture grew Phytobacter ursingii, an emerging gram-negative pathogen. Dialysate remained turbid despite appropriate antibiotics, necessitating catheter removal for refractory PD peritonitis. He transitioned to haemodialysis and completed two weeks of intravenous ceftazidime. Six weeks later, a new PD catheter was inserted successfully, and he resumed CAPD without complications or ultrafiltration failure.
References
1. Bujang, M.A., et al., Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040. Int J Nephrol, 2017. 2017: p. 2735296.
2. Makmun, A., et al., The burden of chronic kidney disease in Asia region: a review of the evidence, current challenges, and future directions. Kidney Res Clin Pract, 2025. 44(3): p. 411-433.
3. Sun, X., et al., Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis. BMC Nephrology, 2024. 25(1): p. 99.
4. Nardelli, L., et al., Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center. BMC Nephrology, 2024. 25(1): p. 163.
5. Sikhipha, T.B., et al., Continuous ambulatory peritoneal dialysis technique failure in adult patients treated at a tertiary hospital in central South Africa: a retrospective analytical study. BMC Nephrology, 2025. 26(1): p. 4.
6. Dong, X., et al., Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China. BMC Nephrology, 2022. 23(1): p. 207.
7. Almuzara, M., et al., Phytobacter spp: the emergence of a new genus of healthcare-associated Enterobacterales encoding carbapenemases in Argentina: a case series. Infection Prevention in Practice, 2024. 6(3): p. 100379.
8. Pillonetto, M., et al., Emended description of the genus Phytobacter, its type species Phytobacter diazotrophicus (Zhang 2008) and description of Phytobacter ursingii sp. nov. 2018. 68(1): p. 176-184.
9. Zhang, G.X., et al., Diverse endophytic nitrogen-fixing bacteria isolated from wild rice Oryza rufipogon and description of Phytobacter diazotrophicus gen. nov. sp. nov. Archives of Microbiology, 2008. 189(5): p. 431-439.
10. Smits, T.H.M., et al., Resolving taxonomic confusion: establishing the genus Phytobacter on the list of clinically relevant Enterobacteriaceae. European Journal of Clinical Microbiology & Infectious Diseases, 2022. 41(4): p. 547-558.
11. Rezzonico, F., et al., Pantoea clinical isolates cannot be accurately assigned to species based on metabolic profiling. Transpl Infect Dis, 2012. 14(2): p. 220-1.
12. Rezzonico, F., et al., Genotypic comparison of Pantoea agglomerans plant and clinical strains. 2009. 9: p. 1-18.
13. Dal Lin, A., et al., Building of a new Spectra for the identification of Phytobacter spp., an emerging Enterobacterales, using MALDI Biotyper. Microbiol Spectr, 2024. 12(10): p. e0110724.
14. Choice, S., et al., Gram-negative sepsis caused by a rare pathogen Phytobacter ursingii. BMJ Case Rep, 2024. 17(4).
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