Acinetobacter peritonitis in patients receiving continuous ambulatory peritoneal dialysis

Little is written on peritonitis caused by Acinetobacter species in patients receiving continuous ambulatory peritoneal dialysis (CAPD). A retrospective review of medical records, dialysis unit charts, and microbiology culture logbooks identified 18 such patients treated at our hospital. All cases were community-acquired, and no common epidemiologic link between cases was detected. The most common manifestations were abdominal pain or tenderness (13 patients) and cloudy dialysate (six patients); only two patients had fever. Peritonitis without localized intra-abdominal abscess formation occurred in all instances. Intraperitoneal aminoglycoside therapy for 3 to 14 days (mean 10.7 days) eradicated infection in 14 cases. Two patients were successfully treated with 4 days of intraperitoneal gentamicin followed by 8 days of oral ciprofloxacin; another was cured with 10 days of IV ceftriaxone. Tenckhoff catheter removal was necessary in only one patient. Unlike pseudomonal or fungal peritonitis associated with CAPD, infection due to Acinetobacter species is generally responsive to antimicrobials alone.