Playing cat and mouse with a gram-negative organism causing peritonitis.

摘要

We report a case of peritonitis involving a mysterious gram-negative bacillus in a patient undergoing peritoneal dialysis (PD). A 39-year-old woman with IgA nephropathy was commenced on nocturnal intermittent PD in 2007 after a failed renal transplant and recurrent vascular access problems. To improve dialysis adequacy, daytime exchanges were needed 1 year later following an episode of uremic pericarditis. The patient presented in 2010 with herfirst episode of peritonitis. Analysis of the peritoneal effluent demonstrated a white cell count of 730/mm~3, with 59% neutrophils. The patient was treated initially with intraperitonealcefazolin and ceftazidime. Gram stain revealed the presence of gram-negative bacilli: cefazolin was discontinued. Resolution of peritoneal fluid cloudiness was noted within 3 days of initiation of antibiotics but the identity of the gram-negative organism remained obscure over the ensuing 3 weeks.