Pantoea peritonitis in peritoneal dialysis: a report of two cases and literature review

Abstract

BackgroundPantoea spp., a non-encapsulated, non-spore-forming Gram-negative rod bacterium that belongs to the Erwiniaceae family, can be found as a colonizer in humans, plants, and the environment, such as water and soil. Although it has the pathogenic potential to cause disease in humans, patients infected with this pathogen generally experience favorable outcomes. In this article, we present two cases of peritoneal dialysis (PD)-associated peritonitis caused by Pantoea spp. along with literature review.Case presentationThe first case is a 66-year-old male patient with end-stage kidney disease (ESKD) on PD, admitted for P. dispersa peritonitis. He presented with abdominal pain and cloudy dialysis effluent, responding well to intraperitoneal vancomycin and cefepime. Antibiotics were deescalated to ceftazidime monotherapy on the basis of antibiotic susceptibility testing. Despite initial recovery with a 3-week course of antibiotics, he developed recurrent peritonitis with P. dispersa, necessitating PD catheter removal and transition to hemodialysis. The second case is a 42-year-old male patient with ESKD on PD who was admitted after 6 days of bloody PD fluid without trauma or associated symptoms. With elevated PD fluid cell counts and positive PD fluid culture showing Streptococcus mitis and P. agglomerans, he was empirically treated for PD-associated peritonitis with intraperitoneal vancomycin and cefepime. Due to a suboptimal response in repeat PD fluid cell counts at day 5, the PD catheter was removed, and he was switched to hemodialysis, followed by a 3-week course of intravenous ceftriaxone.ConclusionsWe described two unique cases of Pantoea peritonitis in PD, recurrent P. dispersa peritonitis and refractory P. agglomerans peritonitis, both of which resulted in PD catheter removal. Our cases indicate the formation of bacterial biofilm as a potential reason for recurrence of infection and underscores the importance of vigilant monitoring and need for PD catheter removal in Pantoea peritonitis.