A Rare Case of Enterococcus gallinarum-Associated Peritonitis and Literature Review

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritonitis is a significant complication of peritoneal dialysis (PD), associated with increased morbidity and mortality.
• Common causes include Gram-positive and Gram-negative bacteria, but fungal and viral infections can also occur.
• Prompt diagnosis via peritoneal fluid analysis (cell count, Gram stain, culture) is crucial before initiating empiric antibiotics.

Observation:

• A case of PD-related peritonitis caused by the rare pathogen *Enterococcus gallinarum* is presented.
• The patient initially received vancomycin and cefepime but showed clinical deterioration.
• Peritoneal fluid cultures ultimately identified *E. gallinarum* as the causative agent.

Findings:

• *Enterococcus gallinarum* peritonitis is exceedingly rare, with only one prior case reported in medical literature.
• Initial broad-spectrum antibiotics were ineffective, underscoring the importance of culture-guided therapy.
• Treatment with daptomycin and cefazolin, based on antimicrobial susceptibility testing, successfully resolved the peritonitis.

Implications:

• This case underscores the importance of considering unusual pathogens in refractory peritonitis cases.
• Accurate and timely microbiological diagnosis is critical for effective treatment of PD-related peritonitis.
• Tailoring antibiotic therapy based on culture sensitivities can lead to successful patient recovery and prevent complications.