Abstract
End-stage renal disease (ESRD) is a major cause of morbidity and mortality. Worldwide, an estimated 10-15% of patients with ESRD are on peritoneal dialysis (PD) [1]. Despite its significant role as a successful method of renal replacement therapy, PD is highly associated with peritonitis and catheter-related infections. Patients on PD, regardless of febrile status, who complain of abdominal pain associated with a cloudy dialysate fluid, are highly suspected of peritonitis. A White Blood Cell (WBC) count greater than 100 mm3 comprising more than 50% polymorphonucleocytes (PMNs) confirms the diagnosis and entails immediate treatment [2]. Peritoneal Dialysis (PD) is one of the 3 well-established modalities of renal replacement therapy used in patients with renal failure. Despite its significant role as a successful method of renal replacement therapy, PD is highly associated with peritonitis and catheterrelated infections. ESBL-producing E. coli (ESBL-EC) is uncommonly isolated in the peritoneal dialysate and are resistant to the currently recommended empiric antibiotics for peritoneal dialysis peritonitis (PDP). The optimal treatment of ESBL-EC cultured in the peritoneal dialysate is still lacking. Here, we report a case of 68 years old female on automated peritoneal dialysis, who presented with symptoms of peritonitis, with a peritoneal dialysate culture positive for ESBL-EC.
Highlights
End-stage renal disease (ESRD) is a major cause of morbidity and mortality
We report a case of 68 years old female on automated peritoneal dialysis, who presented with symptoms of peritonitis, with a peritoneal dialysate culture positive for Extended spectrum beta lactamase (ESBL)-producing E. coli (ESBL-EC)
The incidence of ESBL-producing organisms in peritoneal dialysis peritonitis (PDP) in Bahrain has not been reported, we report the first case of ESBL-producing E.coli (ESBL-EC) PDP in the country
Summary
End-stage renal disease (ESRD) is a major cause of morbidity and mortality. Worldwide, an estimated 10-15% of patients with ESRD are on peritoneal dialysis (PD) [1]. A 68-year-old Bahraini Female known to have ESRD and one-year on Automated Peritoneal Dialysis (APD), presented to the Accident and Emergency Department complaining of a one-day history of generalized abdominal pain and constipation. She had a long history of uncontrolled Diabetes Mellitus Type 2, hypertension and Hepatitis C Virus (HCV). A CBC showed a WBC count of 13.2 10^9/L, 86% of which were polymorphs She was empirically started on Meropenem based on the susceptibility profile of the previously cultured ESBL-EC. Peritoneal equilibrium tests (PET) were not done for the patient
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