Refractory Peritonitis Related to Peritoneal Dialysis Caused by Enterococcus gallinarum

• Published in: Internal Medicine Vol. 63; no. 13; pp. 1907 - 1912
• Main Authors: Yamasaki, Kaho, Ishikawa, Seiko, Suzuki, Takefumi, Tanaka, Yukiko, Oi, Katsuyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.07.2024; Japan Science and Technology Agency
• Subjects: Aged; Ampicillin; Anti-Bacterial Agents - therapeutic use; Ascites; Catheters; Effluents; Enterococcus - isolation & purification; Enterococcus gallinarum; Female; Gastroenteritis; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - etiology; Gram-Positive Bacterial Infections - microbiology; Hemodialysis; Humans; Leukocytes; Meropenem; Meropenem - therapeutic use; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneum; Peritonitis; Peritonitis - diagnosis; Peritonitis - drug therapy; Peritonitis - etiology; Peritonitis - microbiology; Vancomycin; Vancomycin - therapeutic use; peritonitis; Enterococcus gallinarum; peritoneal dialysis
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.2373-23

A 65-year-old woman with a history of peritoneal dialysis undergoing hemodialysis at our hospital presented with a fever after experiencing gastroenteritis symptoms. She had an implanted peritoneal dialysis catheter for draining chylous ascites. After commencing empirical treatment with meropenem, peritoneal effluent samples revealed an increased white blood cell count, and peritonitis was diagnosed. Enterococcus gallinarum was detected in blood and effluent cultures. Meropenem was changed to vancomycin based on susceptibility testing but subsequently restarted and thereafter changed to ampicillin following exacerbation of peritonitis. Finally, catheter removal led to complete recovery. E. gallinarum is vancomycin-resistant and a rare cause of peritonitis.