Citrobacter peritoneal dialysis peritonitis: Rare occurrence with poor outcomes
Journal
International Journal of Medical Sciences
Journal Volume
10
Journal Issue
9
Pages
1092-1098
Date Issued
2013
Abstract
Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short and long-term outcomes in PD-related peritonitis caused by Citrobacter. Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed. Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis ep-isodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months). Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period. ? Ivyspring International Publisher.
SDGs
Other Subjects
amikacin; aminoglycoside antibiotic agent; ampicillin; carbapenem; cefazolin; cefepime; cefmetazole; cefotaxime; ceftazidime; ciprofloxacin; gentamicin; imipenem; immunosuppressive agent; piperacillin plus tazobactam; quinoline derived antiinfective agent; steroid; sultamicillin; vancomycin; adult; aged; antibiotic resistance; antibiotic sensitivity; article; bacterial growth; bacterial peritonitis; bacterium isolate; Citrobacter freundii; Citrobacter koseri; clinical article; clinical feature; constipation; controlled study; diarrhea; Enterobacteriaceae infection; female; hospitalization; human; human cell; laboratory test; male; microbiological examination; mortality; outcome assessment; peritoneal dialysis; rare disease; relapse; retrospective study; treatment failure; Citrobacter; end-stage renal disease; gram-negative bacteria; peritoneal dialysis; peritonitis.; Adult; Aged; Aged, 80 and over; Citrobacter; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Young Adult
Type
journal article