Letter to the Editor
Stenotrophomonas maltophilia: A rare cause of peritonitis in CAPD patients
Stenotrophomonas maltophilia: una causa poco frecuente de peritonitis en diálisis peritoneal
Beatriz Millán-Díaz
, Lourdes González-Tabarés, Carmen Cobelo-Casas, Margarita López-Vázquez, Jesús Calviño-Varela
Corresponding author
Servicio de Nefrología, Hospital Universitario Lucus Augusti, Lugo, Spain
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"subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517301443?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301876?idApp=UINPBA000064" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301876/v1_201712030528/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Stenotrophomonas maltophilia:</span> A rare cause of peritonitis in CAPD patients" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "646" "paginaFinal" => "647" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Beatriz Millán-Díaz, Lourdes González-Tabarés, Carmen Cobelo-Casas, Margarita López-Vázquez, Jesús Calviño-Varela" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Millán-Díaz" "email" => array:1 [ 0 => "beatriz.millan.diaz@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Lourdes" "apellidos" => "González-Tabarés" ] 2 => array:2 [ "nombre" => "Carmen" "apellidos" => "Cobelo-Casas" ] 3 => array:2 [ "nombre" => "Margarita" "apellidos" => "López-Vázquez" ] 4 => array:2 [ "nombre" => "Jesús" "apellidos" => "Calviño-Varela" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Lucus Augusti, Lugo, 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" => "<span class="elsevierStyleItalic">Stenotrophomonas maltophilia:</span> una causa poco frecuente de peritonitis en diálisis peritoneal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> (<span class="elsevierStyleItalic">S. maltophilia</span>) is a non-fermenting gram-negative bacillus. It behaves like an opportunistic pathogen, mainly producing nosocomial infections and affecting immunosuppressed patients. It has low virulence so it is exceptional in healthy patients. The most frequent predisposing factors are having a tumor disease, neutropenia, diabetes mellitus, receiving immunosuppressive treatment or previous treatment with broad-spectrum antibiotics, being a carrier of prosthetic material or permanent vascular devices and have required a prolonged hospitalization.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is characterized by resistance to different groups of antimicrobial agents including beta-lactams, aminoglycosides and fluoroquinolones.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The usual treatment is trimethoprim-sulfamethoxazole associated with one or two more intraperitoneal or intravenous antimicrobials. The period of treatment is prolonged to eradicate the germ and in many cases the removal of the peritoneal catheter is required.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is an uncommon cause of peritonitis in patients on peritoneal dialysis (PD), which leads to great virulence and hospitalization in most cases. In addition, since long-term treatment is required, the onset of other opportunistic diseases and fungal peritonitis is not infrequent increasing the morbidity and mortality of the patients affected.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 54-year-old patient on an automated peritoneal dialysis (APD) program with chronic kidney disease secondary to anticalcineurinics as part of the immunosuppressive treatment of left lung transplantation 3 years before the initiation on PD. During the first year of renal replacement therapy, there were 3 episodes of peritonitis due to polymicrobial etiology, negative culture and <span class="elsevierStyleItalic">Enterococcus faecalis</span>, respectively. After 14 months of onset, a new case of peritonitis was diagnosed with turbid fluid, abdominal pain and 1050 nucleated cells/mm<span class="elsevierStyleSup">3</span> in the peritoneal effluent with 85% polymorphonuclear (PMN). It was empirically treated with intravenous vancomycin and intraperitoneal ceftazidime and with prophylaxis of fungal peritonitis with fluconazole. After an initial improvement, 3 days after the onset of the episode, there was worsening of the general condition and a cell count (2020 nucleated cells with 90% PMN). At that time in the peritoneal fluid it was cultured a multiresistant S. maltophilia sensitive to trimethoprim-sulfamethoxazole that was added to the previous treatment. After a further transient improvement, the cell count increased again, which is why it was decided the removal of the peritoneal catheter and definitive transfer to hemodialysis after several episodes of severe peritonitis caused by multiresistant germs and requiring hospital admission.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our patient had several risk factors; in addition to the triple immunosuppressive therapy for the treatment of lung transplant, the patient had suffered several episodes of infection during the last year. In this same period the patient had required antibiotics to treat upper respiratory infection and required hospital admission for cytomegalovirus infection and <span class="elsevierStyleItalic">Clostridium difficile</span> toxin, with the corresponding antimicrobial treatment during 3 months before infection with S. maltophilia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In several series previously published, it has been possible to preserve the peritoneal catheter in site in 40% of the cases<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–5</span></a> by the administration of 2 or 3 drugs and in another case the patient was cured by adding ceftazidime to the sealed catheter.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> None of these patients were on immunosuppressant therapy.</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: Millán-Díaz B, González-Tabarés L, Cobelo-Casas C, López-Vázquez M, Calviño-Varela J. <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>: una causa poco frecuente de peritonitis en diálisis peritoneal. 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| 2021 July | 91 | 42 | 133 |
| 2021 June | 67 | 26 | 93 |
| 2021 May | 93 | 56 | 149 |
| 2021 April | 152 | 88 | 240 |
| 2021 March | 124 | 45 | 169 |
| 2021 February | 116 | 41 | 157 |
| 2021 January | 74 | 27 | 101 |
| 2020 December | 72 | 17 | 89 |
| 2020 November | 86 | 14 | 100 |
| 2020 October | 59 | 19 | 78 |
| 2020 September | 78 | 21 | 99 |
| 2020 August | 73 | 15 | 88 |
| 2020 July | 69 | 25 | 94 |
| 2020 June | 82 | 19 | 101 |
| 2020 May | 82 | 15 | 97 |
| 2020 April | 62 | 22 | 84 |
| 2020 March | 70 | 18 | 88 |
| 2020 February | 65 | 27 | 92 |
| 2020 January | 84 | 40 | 124 |
| 2019 December | 63 | 27 | 90 |
| 2019 November | 103 | 27 | 130 |
| 2019 October | 57 | 18 | 75 |
| 2019 September | 79 | 16 | 95 |
| 2019 August | 436 | 22 | 458 |
| 2019 July | 641 | 27 | 668 |
| 2019 June | 576 | 27 | 603 |
| 2019 May | 63 | 15 | 78 |
| 2019 April | 87 | 32 | 119 |
| 2019 March | 66 | 27 | 93 |
| 2019 February | 38 | 18 | 56 |
| 2019 January | 35 | 21 | 56 |
| 2018 December | 96 | 40 | 136 |
| 2018 November | 103 | 23 | 126 |
| 2018 October | 66 | 11 | 77 |
| 2018 September | 66 | 13 | 79 |
| 2018 August | 55 | 17 | 72 |
| 2018 July | 44 | 16 | 60 |
| 2018 June | 53 | 11 | 64 |
| 2018 May | 55 | 17 | 72 |
| 2018 April | 46 | 8 | 54 |
| 2018 March | 41 | 9 | 50 |
| 2018 February | 36 | 7 | 43 |
| 2018 January | 37 | 9 | 46 |
| 2017 December | 43 | 14 | 57 |
| 2017 November | 16 | 1 | 17 |
Show all
