Int J Med Sci 2013; 10(9):1092-1098. doi:10.7150/ijms.6251 This issue Cite

Research Paper

Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes

Chia-Ter Chao1,2, Szu-Ying Lee3, Wei-Shun Yang4, Huei-Wen Chen2, Cheng-Chung Fang2,5, Chung-Jen Yen2,6, Chih-Kang Chiang2,7, Kuan-Yu Hung2, Jenq-Wen Huang2✉

1. Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan;
2. Division of Nephrology, Department of Internal Medicine; National Taiwan University Hospital, Taipei, Taiwan;
3. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan;
4. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan;
5. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan;
6. Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan;
7. Department of Integrative diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.

Citation:
Chao CT, Lee SY, Yang WS, Chen HW, Fang CC, Yen CJ, Chiang CK, Hung KY, Huang JW. Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes. Int J Med Sci 2013; 10(9):1092-1098. doi:10.7150/ijms.6251. https://www.medsci.org/v10p1092.htm
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Abstract

Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short- and long-term outcomes in PD-related peritonitis caused by Citrobacter.

Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed.

Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis episodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months).

Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period.

Keywords: Citrobacter, end-stage renal disease, gram-negative bacteria, peritoneal dialysis, peritonitis.


Citation styles

APA
Chao, C.T., Lee, S.Y., Yang, W.S., Chen, H.W., Fang, C.C., Yen, C.J., Chiang, C.K., Hung, K.Y., Huang, J.W. (2013). Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes. International Journal of Medical Sciences, 10(9), 1092-1098. https://doi.org/10.7150/ijms.6251.

ACS
Chao, C.T.; Lee, S.Y.; Yang, W.S.; Chen, H.W.; Fang, C.C.; Yen, C.J.; Chiang, C.K.; Hung, K.Y.; Huang, J.W. Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes. Int. J. Med. Sci. 2013, 10 (9), 1092-1098. DOI: 10.7150/ijms.6251.

NLM
Chao CT, Lee SY, Yang WS, Chen HW, Fang CC, Yen CJ, Chiang CK, Hung KY, Huang JW. Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes. Int J Med Sci 2013; 10(9):1092-1098. doi:10.7150/ijms.6251. https://www.medsci.org/v10p1092.htm

CSE
Chao CT, Lee SY, Yang WS, Chen HW, Fang CC, Yen CJ, Chiang CK, Hung KY, Huang JW. 2013. Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes. Int J Med Sci. 10(9):1092-1098.

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