Successful Treatment of Peritoneal Dialysis Related Peritonitis from Multi-Drug Resistant <i>Sphingomonas paucimobilis</i> with Combination Therapy: A Case Report
- 1 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 2 Nephrology and Dialysis Unit, University of Studies of Campania “Luigi Vanvitelli”, Naples, Italy
- 3 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 4 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 5 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 6 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 7 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 8 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 9 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
- 10 “Ospedale del Mare”, Nephrology and Dialysis Unit, ASL Napoli 1 Centro, Naples, Italy
Abstract
Sphingomonas paucimobilis is an emerging gram-negative aerobic bacterium, generally causing infections in immunocompromised patients. Few data are available about peritonitis in peritoneal dialysis due to this pathogen. The clinical courses and outcomes of peritonitis are variable, with a high frequency of catheter removal and peritoneal dialysis withdrawal. No guidelines are available for the treatment of Sphingomonas paucimobilis related peritonitis, due to its emerging role as pathogen, the high antibiotic resistance and unpredictable antibiotic sensitivity. Here, we describe a case of Sphingomonas paucimobilis peritonitis in a 52-year-old diabetic patient in Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) for 4 months, successfully treated with a combined intraperitoneally administration of meropenem (250 mg/L) and ciprofloxacin (100 mg/L) for 21 days. No hospital admission and change of peritoneal dialysis scheme were needed; no relapses of peritonitis were observed during 18 months of follow-up.
- Winn, W.C., Allen, S.D., Janda, W.M., et al. (2006) Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th Edition, Lippincott Williams & Wilkins, Philadelphia.
- Holmes, B., Owen, R.J., Evans, A., Malnick, H. and Willcox, W.R. (1977) Pseudomonas paucimobilis, a New Species Isolated from Human Clinical Specimens, the Hospital Environment, and Other Sourced. International Journal of Systematic Bacteriology, 27, 33-46. https://doi.org/10.1099/00207713-27-2-133
- Pascale, R., Russo, E., Esposito, I., Leone, S. and Esposito, S. (2013) Sphingomonas paucimobilis Osteomyelitis in an Immunocompetent Patient: A Rare Case Report and Literature Review. New Microbiologica, 36, 423-426.
- Bayram, N., Devrim, I., Apa, H., Gülfdan, G., Türkyılmaz, H.N. and Günay, I. (2013) Sphingomonas paucimobilis Infections in Children: 24 Case Reports. Mediterranean Journal of Hematology and Infectious Diseases, 5, e2013040. https://doi.org/10.4084/mjhid.2013.040
- Lin, J.N., Lai, C.H., Chen, Y.H., Lin, H.L., Huang, C.K., Chen, W.F., Wang, J.L., Chung, H.C., Liang, S.H. and Lin, H.H. (2010) Sphingomonas paucimobilis Bacteremia in Humans: 16 Case Reports and a Literature Review. Journal of Microbiology, Immunology and Infection, 43, 35-42. https://doi.org/10.1016/S1684-1182(10)60005-9
- Lee, J.S., Shin, Y.K., Yoon, J.H., Takeuchi, M., Pyun, Y.R. and Park, Y.H. (2001) Sphingomonas aquatilis sp. nov., Sphingomonas koreensissp. nov. and Sphingomonas taejonensis sp. nov., Yellow-Pigmented Bacteria Isolated from Natural Mineral Water. International Journal of Systematic and Evolutionary Microbiology, 51, 1491-1498. https://doi.org/10.1099/00207713-51-4-1491
- Yılmaz, F., Bora, F. and Ersoy, F. (2018) Peritoneal Dialysis Related Peritonitis by Sphingomonas paucimobilis. Therapeutic Apheresis and Dialysis, 22, 205-206. https://doi.org/10.1111/1744-9987.12637
- Kawasaki, S., Moriguchi, R., Sekya, K., et al. (1994) The Cell Envelope Structure of the Lipopolysaccharide-Lacking Gram-Negative Bacterium Sphingomonas paucimobilis. Journal of Bacteriology, 176, 284-290. https://doi.org/10.1128/jb.176.2.284-290.1994
- Glupczynski, Y., Hansen, W., Dratwa, M., et al. (1984) Pseudomonas paucimobilis Peritonitis in Patients Treated by Peritoneal Dialysis. Journal of Clinical Microbiology, 20, 1225-1226. https://doi.org/10.1128/jcm.20.6.1225-1226.1984
- Swann, R.A., Foulkes, S.J., Holmes, B., Young, J.B., Mitchell, R.G. and Reeders, S.T. (1985) Agrobacterium Yellow Group and Pseudomonas paucimobilis Causing Peritonitis in Patients Receiving Continuous Ambulatory Peritoneal Dialysis. Journal of Clinical Pathology, 38, 1293-1299. https://doi.org/10.1136/jcp.38.11.1293