Department of Microbiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Department of Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Saudi J Kidney Dis Transpl. 2021 Jul-Aug;32(4):1158-1162. doi: 10.4103/1319-2442.338291.
Peritoneal dialysis (PD) peritonitis poses a significant healthcare problem. Most cases are caused by Gram-positive organisms. Newer molecular diagnostic techniques have now enabled identification of previously unrecognized organisms, fully characterizing disease. We present the first case of Paracoccus yeei PD peritonitis reported in the United Kingdom (UK). A 70-year-old woman with chronic renal failure requiring PD presented with abdominal pain and cloudy dialysate. She was systemically well, with a normal white cell count and elevated C-reactive protein at 176. PD fluid was remarkable for 4495 polymorphonuclear leukocytes, 107 monocytes, and 10 red blood cells/cm. No organisms were seen on microscopy. She was diagnosed with PD peritonitis and treated empirically with intraperitoneal vancomycin and oral levofloxacin. After two days, small, nonhemolytic gray-white colonies grew on blood agar. Gram stain of culture showed Gram-negative cocco-bacilli with O-shaped morphology. Phenotypic identification using matrix-assisted laser desorption ionization-time of flight mass spectrometry (Biomerieux) identified P. yeei (identification probability 99.9%). The isolate was sent to the reference laboratory for confirmation and antimicrobial susceptibility testing (AST). At present, there are no European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints to guide AST. Proposed minimum inhibitory concentration (MIC) values were determined using broth dilution method interpreted using EUCAST nonspecies-specific PK-PD breakpoints (where available). The isolate was reported as sensitive to quinolones (ciprofloxacin MIC 0.25 mg/L), piperacillin-tazobactam (MIC 2 mg/L), and meropenem (MIC 0.008 mg/L). P. yeei is an aerobic environmental organism found in soil. It has been associated with PD peritonitis in immunosuppressed patients, although this is the first case in the UK. It is possible that true burden of disease is under-represented, and novel molecular techniques have now enabled identification of this previously unknown organism. In this case, her dog could be a potential source, and good hand hygiene may prevent further infections.
腹膜透析（PD）相关性腹膜炎是一个重大的医疗保健问题。大多数情况下是由革兰氏阳性菌引起的。新的分子诊断技术现在已经能够识别以前未被识别的病原体，从而充分描述疾病。我们报告了首例在英国（UK）发现的副皮氏球菌 PD 相关性腹膜炎病例。一名 70 岁女性患有慢性肾衰竭，需要 PD 治疗，她出现腹痛和混浊的透析液。她全身状况良好，白细胞计数正常，C 反应蛋白升高至 176。PD 液中可见 4495 个多形核白细胞、107 个单核细胞和 10 个红细胞/cm。显微镜检查未见任何病原体。她被诊断为 PD 相关性腹膜炎，并经验性地接受了腹腔内万古霉素和口服左氧氟沙星治疗。两天后，血琼脂上长出小的、非溶血性灰白色菌落。培养物的革兰氏染色显示革兰氏阴性球菌呈 O 形形态。使用基质辅助激光解吸电离飞行时间质谱（Biomerieux）进行表型鉴定，鉴定为副皮氏球菌（鉴定概率 99.9%）。该分离株被送往参考实验室进行确认和抗菌药物敏感性试验（AST）。目前，欧洲抗菌药物敏感性试验委员会（EUCAST）没有指导 AST 的临床折点。使用肉汤稀释法测定最小抑菌浓度（MIC）值，并用 EUCAST 非种特异性 PK-PD 折点（如有）解释（interpreted）。该分离株对喹诺酮类（环丙沙星 MIC 0.25mg/L）、哌拉西林-他唑巴坦（MIC 2mg/L）和美罗培南（MIC 0.008mg/L）敏感。副皮氏球菌是一种存在于土壤中的需氧环境菌。它与免疫抑制患者的 PD 相关性腹膜炎有关，尽管这是英国的首例病例。疾病的真实负担可能被低估了，新的分子技术现在已经能够识别这种以前未知的病原体。在这种情况下，她的狗可能是一个潜在的传染源，良好的手部卫生可能会防止进一步感染。
