{'fraction_non_alphanumeric': 0.02219178082191781, 'fraction_numerical': 0.010958904109589041, 'mean_word_length': 4.955954323001631, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Agrobacterium radiobacter Peritonitis in a Chinese Patient on CAPD

Editor: A 43-year-old Chinese man with end-stage renal failure secondary to polycystic kidney disease was commenced on continuous ambulatory peritoneal dialysis (CAPD) in December 2002. He had been doing well on CAPD and had been free from peritonitis all along. Our patient went on a business trip to a small city in the southern part of China in early April 2004 and stayed there for 2 days. He performed all his CAPD exchanges inside his hotel room. Three days later, our patient presented to our dialysis center because of abdominal pain and cloudy peritoneal dialysis (PD) fluid. Initial PD fluid for microscopy revealed a total white blood cell (WBC) count of 11100/mm3, with 91% neutrophils. A presumptive diagnosis of CAPD peritonitis was made and he was treated with intraper itoneal (IP) cefazolin plus netilmycin. After initiation of IP antibiotic treatment, our patient’s symptoms promptly improved and the PD fluid WBC count dropped to 174/mm3 within 3 days. His PD fluid culture subsequently came back showing Agrobacterium radiobacter, which was sensitive to netilmycin but resistant to cefazolin. He completed a 2-week course of IP antibiotics, with complete resolution of his symptoms and signs of peritonitis. However, our patient developed abdominal pain and cloudy PD fluid 1 week later. A second PD fluid for microscopy showed a total WBC count of 2260/mm3 and the PD fluid culture again grew A. radiobacter. He was started on IP cefuroxime and netilmycin, according to the antibiotic sensitivity test results. His peritonitis responded well to the IP antibiotic treatment. Nevertheless, 2 days after he had finished 14 days of IP antibiotic therapy, his PD fluid became cloudy again. In view of the relapsing nature of his peritonitis, the PD catheter was removed and he was put on temporary hemodialysis. Agrobacterium radiobacter is an aerobic, motile, gramnegative bacillus found primarily in the soil (1). It has only recently been recognized as an opportunistic pathogen in humans (2). To the best of our knowledge, only three cases of CAPD peritonitis caused by A. radiobacter have been reported in the literature (3,4). The clinical course of our case and of the three reported cases are similar in that the peritonitis in all cases initially responded to IP antibiotics but relapsed soon afterward, necessitating the eventual removal of the PD catheter. In fact, nearly all the reported cases of A. radiobacter infection in humans have been associated with the presence of foreign plastic materials, such as intravascular catheters and PD catheters, and effective treatment of the infection often requires removal of the device (2,5). In our patient, the exact source of A. radiobacter causing the peritonitis could not be ascertained. However, the temporal relationship between our patient’s visit to the small city in China and the subsequent development of peritonitis suggested that he had probably acquired the infection there as a result of environmental contamination while he was performing his CAPD exchanges in his hotel room. Our report highlights the fact that A. radiobacter is a rare cause of CAPD peritonitis and that A. radiobacter peritonitis complicating CAPD tends to run a relapsing course after initial response to IP antibiotics. Its clinical behavior resembles that of fungal peritonitis, in which treatment without catheter removal is bound to be futile. Surgical removal of the PD catheter in CAPD patients with Agrobacterium radiobacter peritonitis appears inevitable and should be considered early in the course of treatment.