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Enteric peritonitis caused by Clostridium perfringens in peritoneal dialysis.

Peritonitis is a common complication in peritoneal dialysis (PD). Epidemiology of the causative organism varied over time, but anaerobes are still extremely rare. We describe a second reported case of Clostridium perfringens peritonitis in a peritoneal dialysis patient since 1998. The patient presented with PD-related peritonitis that did not respond to the antibiotic choice recommended by the International Society of Peritoneal Dialysis guidelines. We used piperacillin/tazobactam with good result, when the dialysate culture revealed a gram-positive anaerobe. We postulate that Clostridium perfringen came from an enteric source by translocation. A few studies have implicated diverticular disease and gastric acid inhibitors in PD-related enteric peritonitis, and the results are still controversial. Further study is needed to establish a correlation between bowel pathology and enteric peritonitis in peritoneal dialysis patients.