Brevundimonas vesicularis Peritonitis in a Chronic Peritoneal Dialysis Patient

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Gram-negative peritonitis is a serious complication in chronic peritoneal dialysis (PD) patients, often leading to PD catheter loss.
• Brevundimonas vesicularis is a rare Gram-negative bacterium with limited reported human pathogenicity.

Observation:

• A 41-year-old male on continuous cycling PD presented with culture-negative peritonitis, unresponsive to initial empiric antibiotics (vancomycin, levofloxacin, gentamicin).
• Brevundimonas vesicularis, resistant to levofloxacin, was identified in peritoneal fluid 21 days after symptom onset.
• Despite subsequent treatment with intravenous ceftriaxone and oral amoxicillin-clavulanate, the infection persisted.

Findings:

• The *B. vesicularis* infection proved refractory to multiple antibiotic regimens.
• Peritoneal catheter removal was ultimately required to achieve resolution of the peritonitis.
• This case underscores the challenges in treating rare Gram-negative bacterial infections in PD patients.

Implications:

• Rare bacterial pathogens like *B. vesicularis* should be considered in refractory peritonitis cases, even if initially culture-negative.
• Antibiotic resistance patterns are critical for guiding treatment in PD-associated peritonitis.
• Successful management of such infections may necessitate aggressive interventions, including catheter removal.