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Recurrent peritonitis caused by Serratia marcescens in a diabetic patient receiving continuous ambulatory peritoneal
A A Connacher1, D C Old, G Phillips
1Renal Unit, Dundee Royal Infirmary, University of Dundee Medical School, Ninewells Hospital, UK.
Abstract:
A diabetic patient treated by continuous ambulatory peritoneal dialysis for end-stage renal failure had recurrent peritonitis caused by Serratia marcescens. Thirty-eight isolates of S. marcescens recovered over a 14-month period from peritoneal-dialysis effluent, catheter tips and catheter-exit sites were biotyped and serotyped. The finding that most (90%) of these isolates belonged to the same biotype and serotype suggested that the patient had relapsing infections with the same strain. Similar isolates were recovered from the peritoneal dialysates of another two patients in the same ward, neither of whom developed Serratia-associated peritonitis.
Insights
A diabetic patient experienced recurring peritonitis from Serratia marcescens during peritoneal dialysis. Most bacterial isolates were the same strain, indicating relapsing infections, with similar strains found in other patients.
Area of Science:
- Microbiology
- Nephrology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal failure.
- Peritonitis is a serious complication of CAPD, often caused by bacterial infections.
- Serratia marcescens is an opportunistic pathogen that can cause peritonitis in CAPD patients.
Observation:
- A diabetic patient undergoing CAPD developed recurrent peritonitis over 14 months.
- Thirty-eight isolates of Serratia marcescens were collected from the patient's dialysis effluent, catheter tips, and exit sites.
- Most isolates (90%) shared the same biotype and serotype, suggesting persistent infection with a single strain.
Findings:
- The recurrent peritonitis was likely caused by relapsing infections with the same strain of Serratia marcescens.
- Similar Serratia marcescens strains were identified in two other patients in the same ward.
- These other patients did not develop peritonitis, despite the presence of similar strains.
Implications:
- This case highlights the importance of identifying the specific bacterial strain in recurrent peritonitis to guide treatment.
- Understanding the source and transmission of Serratia marcescens in a hospital ward is crucial for preventing CAPD-related infections.
- Further investigation into host factors and environmental contamination may be needed to explain why some patients develop peritonitis while others do not.