Relapsing Polymicrobial Peritoneal Dialysis-Associated Peritonitis Caused by Rare Non-Fermenting Gram-Negative Pathogens: A Case Report.

Abstract

Introduction: Peritoneal dialysis (PD)-associated peritonitis caused by rare non-fermenting Gram-negative organisms represents a diagnostic and therapeutic challenge, particularly in patients with prolonged antibiotic exposure and biofilm-associated catheter infections.

Case presentation: We report the case of a 44-year-old male PD patient who developed relapsing polymicrobial PD-associated peritonitis involving Elizabethkingia miricola, Brevundimonas diminuta, Stenotrophomonas maltophilia, and Staphylococcus haemolyticus. Despite repeated susceptibility-guided intraperitoneal antibiotic therapy, inflammatory markers and dialyzate leukocytosis persisted. Multiple cultures consistently identified rare non-fermenting Gram-negative pathogens. Following prolonged discussion, the PD catheter was removed, and the patient transitioned to hemodialysis, followed by targeted oral antimicrobial therapy. Clinical and laboratory resolution occurred within 3 weeks after catheter removal.

Conclusion: Rare environmental non-fermenting Gram-negative pathogens should be recognized as clinically relevant causes of relapsing PD-associated peritonitis. Persistent or polymicrobial infections should prompt early consideration of catheter removal in accordance with current ISPD recommendations.