N RAO1, M GARRETT1, K YATES1, S MALONE1, C HOLMES1
1Department of Nephrology, Bendigo Health, BENDIGO, Australia
Background: Stenotrophomonas maltophilia (SM) is a low-virulence gram-negative bacillus that is an uncommon cause of peritoneal dialysis (PD) associated peritonitis. SM peritonitis is associated with high rates of tenckhoff catheter loss and treatment failure. We present a rare case of successfully treated SM PD peritonitis secondary to self-induced water contamination of the extension set.
The case: We present the case of a 75-year-old male with end-stage renal failure secondary to diabetic nephropathy on PD. He developed signs of PD peritonitis, 4 weeks after troubleshooting his blocked catheter by rinsing the extension set under tap water. The peritonitis progressed despite early sampling and initial empirical antibiotics. SM was cultured and he was successfully treated with IP Cotrimoxazole four times a day for three weeks and oral moxifloxacin 400mg daily for three weeks. This allowed preservation of his Tenckhoff catheter and he remained on peritoneal dialysis. This case highlights the importance of prompt treatment once this organism is identified and ongoing need for continued education regarding sterile PD technique for all patients on peritoneal dialysis.
Conclusion: SM is a rare cause of PD peritonitis and is associated with a high rate of PD catheter loss and failure of antibiotic therapy. Early treatment with appropriate combination antimicrobial therapy, given the high resistance pattern of this organism can lead to catheter preservation and successful treatment of peritonitis.
I am final year renal advanced trainee with an interest in home therapies and supportive care. I am also a general physician with an interest in peri-operative medicine. Apart from medicine, I enjoy skiing, making terrariums and propagating indoor plants.