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Bruno V, Tjon J, Lin S, et al. Peritoneal dialysis-related peritonitis caused by Gordonia bronchialis: first pediatric report. Pediatr Nephrol. 2021;37(1):217-220doi: 10.1007/s00467-021-05313-3.
Bruno, V., Tjon, J., Lin, S., Groves, H., Kazmi, K., Zappitelli, M., & Harvey, E. (2022). Peritoneal dialysis-related peritonitis caused by Gordonia bronchialis: first pediatric report. Pediatric nephrology (Berlin, Germany), 37(1), 217-220. https://doi.org/10.1007/s00467-021-05313-3
Bruno, Valentina, et al. "Peritoneal dialysis-related peritonitis caused by Gordonia bronchialis: first pediatric report." Pediatric nephrology (Berlin, Germany) vol. 37,1 (2022): 217-220. doi: https://doi.org/10.1007/s00467-021-05313-3
Bruno V, Tjon J, Lin S, Groves H, Kazmi K, Zappitelli M, Harvey E. Peritoneal dialysis-related peritonitis caused by Gordonia bronchialis: first pediatric report. Pediatr Nephrol. 2022 Jan;37(1):217-220. doi: 10.1007/s00467-021-05313-3. Epub 2021 Oct 11. PMID: 34633526; PMCID: PMC8503381.
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Pediatr Nephrol. 2022 Jan;37(1):217-220. doi: 10.1007/s00467-021-05313-3. Epub 2021 Oct 11.

Peritoneal dialysis-related peritonitis caused by Gordonia bronchialis: first pediatric report.

Pediatric nephrology (Berlin, Germany)

Valentina Bruno, James Tjon, Sandy Lin, Helen Groves, Kescha Kazmi, Michael Zappitelli, Elizabeth Harvey

Affiliations

  1. Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. [email protected].
  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada. [email protected].
  3. Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada.
  4. Department of Nursing, The Hospital for Sick Children, Toronto, ON, Canada.
  5. Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
  6. Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.
  7. Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.

PMID: 34633526 PMCID: PMC8503381 DOI: 10.1007/s00467-021-05313-3

Abstract

INTRODUCTION: Gordonia species, aerobic, weakly acid-fast, Gram-positive bacilli, are a rare cause of peritonitis in patients undergoing peritoneal dialysis (PD). We report the first pediatric case of PD-related peritonitis caused by Gordonia bronchialis.

CASE PRESENTATION: A 13-year-old girl with chronic kidney disease (CKD) stage 5D, on continuous cycling PD (CCPD) for 8 years, presented with cloudy PD effluent, with no abdominal discomfort or fever. Intra-peritoneal (IP) loading doses of vancomycin and ceftazidime were started at home after obtaining a PD effluent sample, which showed WBC 2,340 × 10 /L (59% neutrophils) and Gram-positive bacilli. On admission, she was clinically well and afebrile, with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection, so vancomycin was discontinued, and IP ceftazidime and cefazolin were started, following a loading dose of intravenous cefazolin. Gordonia species grew after 5 days of incubation and later identified as Gordonia bronchialis. IP vancomycin was restarted as monotherapy, empirically for a total of 3 weeks therapy. A 2-week course of oral ciprofloxacin was added, based on susceptibility testing. PD catheter replacement was advised due to the risk of recurrence but was refused. A relapse occurred 16 days after discontinuing antibiotics, successfully treated with a 2-week course of IP ceftazidime and vancomycin. The PD catheter was removed and hemodialysis initiated. She received a further 2-week course of oral ciprofloxacin and amoxicillin-clavulanate post PD catheter removal.

CONCLUSIONS: Gordonia bronchialis is an emerging pathogen in PD peritonitis and appears to be associated with a high risk of relapse. PD catheter replacement is strongly suggested.

© 2021. The Author(s), under exclusive licence to International Pediatric Nephrology Association.

Keywords: Child; Gordonia bronchialis; Peritoneal dialysis; Peritonitis

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