Corynebacterium species: an uncommon agent of peritoneal dialysis-related peritonitis and a challenging treatment

• Autor(a) principal: Ferreira,Joel
• Data de Publicação: 2015
• Outros Autores: Teixeira e Costa,Fernando, Ramos,Aura
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692015000200006
• topic: Antibiotics; Corynebacterium; peritoneal dialysis; peritonitis

Introduction: Corynebacterium is a component of normal skin flora and it is responsible for an increasing incidence of nosocomial infections in the last decades. Peritonitis and exit-site infections caused by this microorganism are uncommon but have a significant clinical impact due to their high relapsing rate. The ideal therapeutic approach in these situations is not yet clearly defined. Methods: Retrospective analysis of Corynebacterium spp peritonitis in a peritoneal dialysis unit between 2006 and 2013 and characterization as to its frequency, treatment and clinical outcomes. Results: During the reporting period, nine patients (7.8%) had Corynebacterium peritonitis, accounting for a total of 18 episodes of infection caused by this microorganism. The majority of patients (55.6%) had more than one episode of Corynebacterium peritonitis, with a relapsing rate after the first episode of 22.2% and 33.3% repeat peritonitis cases. The relapsing rate was even higher after the second episode (33.3%). Five patients (55.6%) were treated with vancomycin and only one of them required antibiotic switch to linezolid because of hypersensitivity reaction; the same happened with one of four patients treated with cephalosporins. Cure was achieved in all cases and treatment duration was on average 17.9 days per episode. There was no need for catheter removal or peritoneal dialysis dropout, and we did not record any death related to peritonitis. Conclusions: The Corynebacterium peritonitis rate in our unit was high. The infection proved to be highly relapsing but with excellent response to antibiotics and without any adverse clinical outcome. Therefore, in relapsing and repeat peritonitis caused by this strain, one would recommend preservation of the dialysis catheter, and cure may be exclusively achieved with 14 to 21 days of antibiotic therapy with vancomycin or even cephalosporin