A Case of Peritonitis due to Listeria Monocytogenes Pomplicating on Continuous Ambulatory Peritonial Dialysis Patient / 대한신장학회잡지

ABSTRACT

Peritonitis in continuous ambulatory peritoneal dialysis is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed infection and fungal infection actively involved in the order named. Coagulate-negative Staphylococcus, Streptococcus, Staphylococcus aureus and Enterococcus cause most of the gram positive bacterial infections, and cases with other pathogens are very rare. We hereby report a case of peritonitis by Listeria Monocytogenes that was not responsive to the usual antibiotics for CAPD-associated peritonitis. A 58-year-old male who has been treated with CAPD for 17 years visited our hospital for abdominal pain, fever and turbid peritoneal fluid. He was diagnosed as diabetes mellitus 20 years ago. White blood cell and neutrophil count increased at the initial peritoneal fluid analysis, so we diagnosed him as CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of cefazolin/tobramycin, which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen was also proven ineffective. On the sixth hospital day, L. Monocytogenes was cultured in the peritoneal fluid sampled on the first visiting day. So we accordingly changed the antibiotics for ampicillin/sulbactam, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in immunosuppressive patients such as the elderly, caused either by diabetes or by taking immunosuppressive agent, if they do not respond to the usual antibiotics, we should consider the possible infection by unusual pathogens. Gram positive rod in peritoneal fluid is a supporting evidence of peritonitis by L. monocytogenes.