V HERON1, A YOUNG1, S WILKINSON1, R BARTON1, A GUPTA1
1Darling Downs Hospital And Health Service, Toowoomba, Australia
Background: Peritonitis is a common and serious complication seen in peritoneal dialysis (PD) patients. Kocuria, a genus of gram-positive organisms, has been identified as commensal flora of the human skin and mucosa. It has a close microbiological resemblance to coagulase negative staphylococci and this has made its diagnosis difficult. New laboratory techniques have aided the identification of kocuria species. Sixteen cases of kocuria-associated peritonitis have been reported in the literature with two cases requiring removal of the PD catheter. We present a single centre experience of two cases of kocuria peritonitis necessitating catheter removal.
Case report: Two cases of kocuria peritonitis were treated by the Darling Downs Renal Service in 2017. Both cases occurred in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and each presented with abdominal pain and cloudy dialysate. The first patient was treated with intraperitoneal vancomycin and despite his initial improvement, he developed worsening abdominal pain. His dialysate cell count rose and the catheter was removed on day eight of presentation. Intravenous cephazolin was continued for a further week. The second patient completed six days of intraperitoneal cephazolin before the peritoneal catheter was removed. A further two weeks of intravenous cephazolin was finished.
Conclusions: Kocuria peritonitis may be a previously under-recognised cause of PD peritonitis. It has predominately been reported in CAPD patients. Although it is a known commensal flora of the skin and mucosa, the requirement for peritoneal catheter removal in two cases of kocuria peritonitis suggests that it can be a clinically important pathogen in humans, including PD patients.
Vanessa Heron is an advanced trainee in nephrology currently working at Toowoomba Hospital, Queensland.