Letter to the Editor
Paracoccus yeei peritonitis in peritoneal dialysis
Peritonitis causada por Paracoccus yeei en diálisis peritoneal
Aránzazu Sastre
, Jose González-Arregoces, Igor Romainoik, Santiago Mariño, Cristina Lucas, Elena Monfá, George Stefan, Benjamin de León, Mario Prieto
Corresponding author
Sección de Nefrología, Complejo Asistencial Universitario de León, León, Spain
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"email" => array:1 [ 0 => "aranchasastre@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Jose" "apellidos" => "González-Arregoces" ] 2 => array:2 [ "nombre" => "Igor" "apellidos" => "Romainoik" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Mariño" ] 4 => array:2 [ "nombre" => "Cristina" "apellidos" => "Lucas" ] 5 => array:2 [ "nombre" => "Elena" "apellidos" => "Monfá" ] 6 => array:2 [ "nombre" => "George" "apellidos" => "Stefan" ] 7 => array:2 [ "nombre" => "Benjamin" "apellidos" => "de León" ] 8 => array:2 [ "nombre" => "Mario" "apellidos" => "Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Nefrología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Peritonitis causada por <span class="elsevierStyleItalic">Paracoccus yeei</span> en diálisis peritoneal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Peritonitis is defined as peritoneal inflammation caused by microorganisms, with the presence of cloudy peritoneal fluid, a leukocyte count of more than 100 per microlitre and leukocytes accounting for more than 50% of polymorphonuclear cells. It remains the most significant complication deriving from the dialysis technique itself. It is generally caused by Gram-positive skin bacteria such as <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and <span class="elsevierStyleItalic">Staphylococcus aureus</span>, or by enterobacteria and fungi. An intact peritoneum and the defence mechanisms of the mesothelium are probably the most significant barriers that help prevent the development of peritonitis. Prevention is the fundamental weapon, and the routes by which microorganisms enter the peritoneal cavity should be acted on: peritoneal access, connection systems, dialysis solutions and examinations that help enable infection.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Paracoccus yeei</span> is a non-fermenting bacterium in the environment that is present in soil. It is the bacterium that caused the episode of peritonitis in the case that we are reporting.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our case is a 46-year-old woman diagnosed with adult polycystic kidney disease, on a regimen of automated peritoneal dialysis for the last 3 years, with no prior episodes of peritonitis. The patient lived with a small dog she routinely take out for walks.</p><p id="par0020" class="elsevierStylePara elsevierViewall">She visited the dialysis unit because she noticed cloudy fluid in the peritoneal effluent drainage. There was no fever or nausea, and her bowel movements were normal. She had slight abdominal discomfort, and an examination showed signs of peritoneal irritation. A peritoneal fluid cell count was performed and found 790<span class="elsevierStyleHsp" style=""></span>leukocytes/mcl, with 75% polymorphonuclear cells. Samples were sent for the performance of a Gram stain, and cultures in blood culture and conventional media. A diagnosis of peritonitis was confirmed and treatment was started according to our site's protocol, with intraperitoneal vancomycin and ceftazidime. Empirical treatment of peritonitis was to be done with a combination of broad spectrum antibiotics targeting Gram-positive and Gram-negative microorganisms. The patient continued on an outpatient regimen, since her general condition was good, with daily self-administration of intraperitoneal ceftazidime and visits to the hospital to undergo follow-up cell counts. At 48<span class="elsevierStyleHsp" style=""></span>h she received a positive culture in a blood culture medium for <span class="elsevierStyleItalic">Paracoccus yeei</span>. No bacteria were seen on a Gram stain, and a conventional culture was negative. Peritonitis results in morbidity and mortality, and is a cause of hospitalization in the most impaired patients. However, it can generally be treated on an outpatient basis, as in our case.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Paracoccus yeei</span> was formerly classified as a eugonic oxidizer group 2 (EO-2) strain. In 2003, new molecular techniques identified this new species. It consists of small non-fermenting aerobic Gram-negative coccobacilli, with O-shaped morphology. The bacterium is catalase- and oxidase-positive. Its phenotype is identified by PCR and confirmed with 16S rRNA gene sequencing. It was identified for the first time in the peritoneal fluid in a peritoneal dialysis patient in Pennsylvania<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and subsequently anecdotally identified in other cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> It mainly affects immunodepressed patients and may cause skin infections,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> myocarditis,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> arthritis,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> keratitis and corneal graft rejection.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is found naturally in soil. Given that our patient had a small dog, we thought this could have brought the bacteria to her house, that the patient could have contaminated herself with it if she failed to comply with strict hand-washing and it could have passed to the peritoneum during connection.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Paracoccus yeei</span> bacterium is sensitive to beta-lactams, especially aminopenicillins and carbapenems, as well as third-generation cephalosporins. Intraperitoneal administration of antibiotics achieves improvement, as there is a higher concentration of bacteria at the infected site, and easily leads to eradication of the bacterium.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The course of our patient's peritonitis was good, with a gradual drop in leukocytes in the effluent from the time when she received the culture. Vancomycin was suspended and treatment was completed with ceftazidime for 14 days.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This bacterium is rarely identified in clinical samples. Animals such as a horse<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> or, in our case, a dog may be the vehicle for human contamination.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We believe this to be the first reported case of <span class="elsevierStyleItalic">Paracoccus yeei</span> peritonitis in Spain.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sastre A, González-Arregoces J, Romainoik I, Mariño S, Lucas C, Monfá E, et al. <span class="elsevierStyleItalic">Paracoccus yeei</span> peritonitis in peritoneal dialysis. 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Pagniez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2009.03.030" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "e173" "paginaFinal" => "e174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19556157" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003600000004/v1_201612030031/S2013251416300852/v1_201612030031/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003600000004/v1_201612030031/S2013251416300852/v1_201612030031/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251416300852?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 63 | 44 | 107 |
| 2024 September | 64 | 41 | 105 |
| 2024 August | 81 | 73 | 154 |
| 2024 July | 83 | 36 | 119 |
| 2024 June | 85 | 25 | 110 |
| 2024 May | 94 | 41 | 135 |
| 2024 April | 66 | 30 | 96 |
| 2024 March | 63 | 20 | 83 |
| 2024 February | 57 | 38 | 95 |
| 2024 January | 56 | 29 | 85 |
| 2023 December | 44 | 25 | 69 |
| 2023 November | 53 | 30 | 83 |
| 2023 October | 114 | 30 | 144 |
| 2023 September | 87 | 25 | 112 |
| 2023 August | 66 | 26 | 92 |
| 2023 July | 72 | 26 | 98 |
| 2023 June | 58 | 18 | 76 |
| 2023 May | 82 | 33 | 115 |
| 2023 April | 63 | 21 | 84 |
| 2023 March | 68 | 26 | 94 |
| 2023 February | 80 | 23 | 103 |
| 2023 January | 76 | 26 | 102 |
| 2022 December | 67 | 33 | 100 |
| 2022 November | 107 | 26 | 133 |
| 2022 October | 106 | 37 | 143 |
| 2022 September | 84 | 31 | 115 |
| 2022 August | 72 | 36 | 108 |
| 2022 July | 75 | 45 | 120 |
| 2022 June | 89 | 39 | 128 |
| 2022 May | 96 | 38 | 134 |
| 2022 April | 127 | 48 | 175 |
| 2022 March | 99 | 64 | 163 |
| 2022 February | 107 | 46 | 153 |
| 2022 January | 126 | 44 | 170 |
| 2021 December | 102 | 49 | 151 |
| 2021 November | 110 | 40 | 150 |
| 2021 October | 120 | 54 | 174 |
| 2021 September | 99 | 40 | 139 |
| 2021 August | 87 | 42 | 129 |
| 2021 July | 77 | 31 | 108 |
| 2021 June | 256 | 38 | 294 |
| 2021 May | 116 | 49 | 165 |
| 2021 April | 247 | 49 | 296 |
| 2021 March | 147 | 38 | 185 |
| 2021 February | 108 | 20 | 128 |
| 2021 January | 57 | 16 | 73 |
| 2020 December | 60 | 17 | 77 |
| 2020 November | 67 | 21 | 88 |
| 2020 October | 61 | 32 | 93 |
| 2020 September | 70 | 14 | 84 |
| 2020 August | 76 | 18 | 94 |
| 2020 July | 64 | 15 | 79 |
| 2020 June | 92 | 25 | 117 |
| 2020 May | 94 | 24 | 118 |
| 2020 April | 75 | 21 | 96 |
| 2020 March | 61 | 13 | 74 |
| 2020 February | 85 | 24 | 109 |
| 2020 January | 80 | 25 | 105 |
| 2019 December | 84 | 24 | 108 |
| 2019 November | 91 | 24 | 115 |
| 2019 October | 70 | 25 | 95 |
| 2019 September | 83 | 16 | 99 |
| 2019 August | 53 | 14 | 67 |
| 2019 July | 66 | 22 | 88 |
| 2019 June | 66 | 33 | 99 |
| 2019 May | 67 | 34 | 101 |
| 2019 April | 103 | 46 | 149 |
| 2019 March | 67 | 22 | 89 |
| 2019 February | 43 | 19 | 62 |
| 2019 January | 76 | 19 | 95 |
| 2018 December | 191 | 43 | 234 |
| 2018 November | 186 | 16 | 202 |
| 2018 October | 216 | 26 | 242 |
| 2018 September | 114 | 15 | 129 |
| 2018 August | 71 | 19 | 90 |
| 2018 July | 61 | 12 | 73 |
| 2018 June | 62 | 16 | 78 |
| 2018 May | 81 | 14 | 95 |
| 2018 April | 77 | 11 | 88 |
| 2018 March | 66 | 9 | 75 |
| 2018 February | 46 | 6 | 52 |
| 2018 January | 56 | 8 | 64 |
| 2017 December | 307 | 19 | 326 |
| 2017 November | 188 | 13 | 201 |
| 2017 October | 40 | 10 | 50 |
| 2017 September | 71 | 14 | 85 |
| 2017 August | 111 | 11 | 122 |
| 2017 July | 86 | 7 | 93 |
| 2017 June | 106 | 12 | 118 |
| 2017 May | 80 | 14 | 94 |
| 2017 April | 84 | 13 | 97 |
| 2017 March | 63 | 45 | 108 |
| 2017 February | 34 | 11 | 45 |
| 2017 January | 40 | 7 | 47 |
| 2016 December | 37 | 5 | 42 |
| 2016 November | 34 | 8 | 42 |
| 2016 October | 7 | 2 | 9 |
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