A Unique of &lt;i&gt;Rhizobium radiobacter&lt;/i&gt; Peritoneal Dialysis Catheter-related Peritonitis from a Cat Bite

Benjamin Bluen,Lukasz Kiljanek,Larry Krevolin,Hans P Schlecht,Kyle Krevolin

doi:10.12691/ajmcr-6-6-1

Abstract

Peritoneal dialysis catheter-related peritonitis is typically related to catheter insertion or hygiene. Organisms usually manifest as gram positive organisms typically Staphylococci or gram negative bacilli that typically colonize aqueous environments such as Pseudomonas spp. as well as other unusual mycobacterial or fungal pathogens. The authors present a unique case of peritoneal dialysis catheter-related peritonitis manifesting after the patientâs cat bit the proximal aspect of the catheter attachment tubing. After failure to clinically improve after outpatient treatment of Staphylococcus hemolyticus and Staphylococcus capitis catheter related-peritonitis with intraperitoneal Vancomycin and empiric Gentamicin, repeat peritoneal cultures were sent that demonstrated growth of Rhizobium radiobacter. The patient was admitted inpatient and treatment was tailored to intraperitoneal Cefepime with clearance of peritoneal cultures and rapid improvement in peritoneal white blood cell count and the patientâs clinical condition. The patient was subsequently discharged on oral Ciprofloxacin with complete recovery and catheter salvage.

Highlights

A formerly reclassified from Agrobacterium class by 16s RNA analysis [1], is an aerobic gram-negative, motile, non-spore forming oxidase positive bacillus
A 38 year-old female with end-stage renal disease on intermittent nocturnal peritoneal dialysis via Tenkhoff catheter for over two years secondary to type-1 diabetes mellitus presented to Hahnemann University Hospital in Philadelphia, Pennsylvania in October 2016 upon her nephrologist’s request due to positive IP cultures
Her symptoms began several days after her cat bit her peritoneal dialysis (PD) connection tubing just distal to the Tenkhoff catheter attachment

Summary

Introduction

A formerly reclassified from Agrobacterium class by 16s RNA analysis [1], is an aerobic gram-negative, motile, non-spore forming oxidase positive bacillus. Due to the infrequent incidence of R. radiobacter, large clinical trials assessing its impact and treatment options are lacking

Case Presentation

Discussion

Findings

Conclusion