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Xanthomonas maltophilia peritonitis in uremic patients receiving continuous ambulatory peritoneal dialysis
Abstract:
Xanthomonas maltophilia peritonitis has been only occasionally reported in patients receiving continuous ambulatory peritoneal dialysis. We present a series of six cases of peritonitis caused by such bacteria, accounting for 1.5% of all peritonitis episodes encountered in our renal unit over the past 5 years. Recent bacterial peritonitis treated with broad-spectrum antibiotics was the major risk factor, and the outcome was poor with medical treatment alone. Secondary peritonitis, especially fungal, was common and probably related to the prolonged course of antibiotics. All patients eventually required removal of the catheter, either because the effluent failed to clear up or because of secondary peritonitis. We suggest that X maltophilia peritonitis be treated with double antibiotics as soon as it is diagnosed. To prevent the development of superimposed infection after prolonged administration of antibiotics, the Tenckhoff catheter should be removed if the peritonitis fails to respond to a short course of antibiotics.
Insights
Xanthomonas maltophilia peritonitis in dialysis patients is rare but serious. Prompt double antibiotic treatment and potential catheter removal are crucial for managing this infection.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Xanthomonas maltophilia peritonitis is infrequently reported in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- This study details six cases, representing 1.5% of peritonitis episodes over five years in a specific renal unit.
Purpose of the Study:
- To report on cases of Xanthomonas maltophilia peritonitis in CAPD patients.
- To identify risk factors and treatment outcomes.
- To propose management strategies for this specific type of peritonitis.
Main Methods:
- Retrospective case series analysis.
- Review of patient records for peritonitis episodes.
- Clinical and microbiological data evaluation.
Main Results:
- Recent bacterial peritonitis treated with broad-spectrum antibiotics was a significant risk factor.
- Medical treatment alone yielded poor outcomes.
- Secondary fungal peritonitis occurred frequently, likely due to prolonged antibiotic use.
- Catheter removal was ultimately necessary for all patients due to persistent infection or secondary peritonitis.
Conclusions:
- Xanthomonas maltophilia peritonitis requires prompt diagnosis and treatment with dual antibiotics.
- If peritonitis does not resolve with initial antibiotic therapy, Tenckhoff catheter removal is recommended to prevent superimposed infections after prolonged antibiotic administration.