Enteric peritonitis caused by Clostridium perfringens in peritoneal dialysis

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritonitis is a frequent complication in patients undergoing peritoneal dialysis (PD).
• The spectrum of causative organisms in PD peritonitis is well-documented, with anaerobic infections being exceptionally rare.
• Previous literature indicates anaerobes account for less than 1% of PD peritonitis cases.

Observation:

• This report details a rare case of Clostridium perfringens peritonitis in a PD patient.
• The patient's peritonitis initially resisted antibiotics recommended by the International Society of Peritoneal Dialysis guidelines.
• Dialysate culture confirmed a gram-positive anaerobic organism, later identified as Clostridium perfringens.

Findings:

• The patient's infection was successfully treated with piperacillin/tazobactam, an antibiotic not typically first-line for PD peritonitis.
• Clostridium perfringens, an anaerobic bacterium, was identified as the causative agent.
• This represents the second reported instance of Clostridium perfringens peritonitis in PD since 1998.

Implications:

• The case suggests that Clostridium perfringens, originating from an enteric source via translocation, can cause PD peritonitis.
• Current understanding of the link between bowel pathology (e.g., diverticular disease) and enteric peritonitis in PD patients remains controversial.
• Further research is warranted to explore potential correlations between gastrointestinal conditions and the occurrence of anaerobic peritonitis in PD.