Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Colombia

BackgroundIn the present report case, we show a peritonitis infection in a continuous ambulatory peritoneal dialysis (CAPD) patient in Colombia. We isolated Rhodococcus equi in the peritoneal fluid culture. Rhodococcus equi is a rare pathogen in immunocompetent people. Rhodococcal peritonitis complicating CAPD has only been reported in few cases, and experience in its treatment is limited. Antimicrobial treatment is unsuccessful because of the virulence and resistance of the Rhodococcus equi. So, the removal of the catheter determines the clinical resolution in most of the cases. In our case, we present the resolution with a combined antibiotic therapy.Case presentationWe present the case of a 50-year-old female patient with chronic kidney disease secondary to diabetic nephropathy. The patient reported to our unit with abdominal pain 6 months after the start of the treatment with CAPD. An intraperitoneal empirical antibiotic scheme was initiated according to the guidelines of the International Society for Peritoneal Dialysis. Patient denies contact with farm animals in her daily life. After 7 days of treatment, Rhodococcus equi was found in the culture. It was decided to extrapolate antibiotic regimen based on the studies of immunocompromised patients suffering from pulmonary infections. The removal of the peritoneal dialysis catheter is decided, but the patient refuses to undertake the procedure. The patient progresses without abdominal pain, and the antibiotic treatment is changed by azithromycin 500 mg daily and performing peritoneal dialysis in CAPD mode.ConclusionsThis case, like the previously published ones, highlights the limitations in the treatment of Rhodococcus equi due to the limited number of reported cases of this pathogen and the absence of standard treatment protocols leading to variable response rates. The therapeutic resolution was due to the prolonged use of antibiotic treatment and being aware of the potential increase of the morbidity.