12/27/2022 0 Comments Gram positive cocci in clustersNinety percent of infections caused by Enterococcus species are attributed to E. They cause urinary tract infections, intra-abdominal infections, bacteremia, and nosocomial infections that are antibiotic-resistant frequently. avium to antibiotic are listed in Table 1.Įnterococcus species are normal commensals of human gut flora. Sensitivities were done using a broth microdilution technique. The sensitivities of E. Species identification was made by VITEK 2. avium in both aerobic and anaerobic bottles. The peritoneal fluid WBC count started to get better with 11,715 cells/uL on day 2,4502 cells/uL on day 3,1574 cells/uL on day four and got worse to 10,097 cells/uL on day 5. The patient underwent coronary intervention because of non-ST elevation myocardial infarction (NSTEMI) and had successful angioplasty of in-stent restenosis of ramus intermedius. The patient was started on treatment for peritonitis with empiric intraperitoneal vancomycin and ceftazidime. Peritoneal fluid Gram stain revealed >100 WBC, and no organisms were seen. The peritoneal fluid effluent revealed peritoneal fluid WBC 14,309 cells/uL, with 89% predominant neutrophils. Investigations revealed electrocardiogram with 80 bpm in sinus rhythm, premature complexes, and nonspecific conduction delay as shown in Figure 1. Laboratory data showed hemoglobin 7.8 g/dL, white blood cell (WBC) count 7220 mm 3, platelet count 150,000 mm 3, sodium 131 mmol/L, potassium 4.3 mmol/L, bicarbonate 20 mmol/L, blood urea nitrogen 76 mg/dL, creatinine 12.92 mg/dL, albumin 2.8 g/dL, and troponin I 15.01 ng/mL. The rest of the physical examination was unremarkable. Abdominal examination revealed a distended, tender abdomen with a peritoneal dialysis catheter in the left lower quadrant. Physical examination revealed that the patient was in sinus rhythm, with no rubs or gallops or murmurs. The vital signs in the ER were a temperature of 36.5 centigrade, pulse rate of 80 beats per minute (bpm), respiratory rate of 18 breaths per minute, and blood pressure of 123/76 mmHg. Home medications include aspirin 81 milligrams (mg) daily, ticagrelor 90 mg twice a day, calcitriol 0.25 micrograms daily, carvedilol 6.25 mg twice a day, olmesartan 40 mg daily, vitamin d2 50,000 units weekly, and insulin sliding scale. Other history details include hypertension, diabetes, hyperlipidemia, and coronary artery disease with four-vessel coronary artery bypass grafting. Past medical history was significant for polycystic kidney disease resulting in end-stage renal disease, bilateral nephrectomies with living unrelated kidney transplant that failed after 13 years, and he was on peritoneal dialysis for two years. The patient was having diarrhea and abdominal pain for two days before the presentation. Palpitations were sudden in onset and woke up the patient from sleep and were persistent, which prompted him to seek medical attention. The peritoneal dialysis catheter was removed, and the dialysis modality has been switched to hemodialysis because of refractory peritonitis.Ī 60-year-old male was admitted with a chief complaint of palpitations, abdominal pain, and diarrhea. The patient was treated with linezolid after failing to respond to vancomycin. The peritoneal fluid analysis was consistent with peritonitis, and peritoneal fluid culture grew E. A 60-year-old male on peritoneal dialysis presented with palpitations, abdominal pain, diarrhea, and cloudy effluent. We report a rare case of peritonitis caused by Enterococcus avium. Gram-positive organisms are the frequent cause of peritonitis compared to Gram-negative organisms. There has been recognition of peritonitis caused by unusual organisms because of improved microbiological detection techniques. High vigilance is required from healthcare providers involved in the management of these patients to prevent this complication. Peritonitis is a severe complication encountered in patients undergoing peritoneal dialysis, often causing high morbidity and mortality.
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