Nosocomial peritonitis related to contaminated dialysate warming water

Abstract

cultures of effluent on both days grew A. calcoaceticus var. anitratus. On the second day of infection a culture of the water bath used to warm dialysate bottles also yielded 19,000 colony-forming units per milliliter (du/ml) of the same organism, which also had the same antibiogram as that found in the patient's dialysis effluent. Gentamicin, administered via oddnumbered dialysates and in a single intravenous dose, resulted in sterile cultures of effluent and clearance of symptoms by the time dialysis was discontinued on the thirteenth hospital day. That evening peritoneal dialysis had to be resumed for 4 additional days. On the second day after its resumption and daily until discontinued, Candida albicans was cultured from effluent. The patient remained asymptomatic, and Gram stains of the effluent were negative for bacteria, yeasts, and hyphae, but showed numerous PMNLs. On the twenty-eighth hospital day the patient died of aspiration pneumonia. While autopsy findings included purulent ascites, peritonitis, and a cul-de-sac abscess, cultures were not obtained.