Letter to the Editor
Peritonitis caused by Pantoea agglomerans in peritoneal dialysis
Peritonitis causada por Pantoea agglomerans en diálisis peritoneal
Aránzazu Sastre
, Jose E. González-Arregoces, Igor Romainoik, Santiago Mariño, Cristina Lucas, Elena Monfá, George Stefan, Benjamin de León, Mario Prieto
Corresponding author
Servicio de Nefrología, Complejo Asistencial Universitario de León, León, Spain
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Ionized calcium plus that bound to citrate and bicarbonate form the diffusible calcium in blood; all DF calcium is diffusible. Note that the concentration of blood-diffusible calcium is greater than that of the DF leaving the dialyser.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Pérez-García, Marta Albalate, Patricia De Sequera, Mayra Ortega" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Pérez-García" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Albalate" ] 2 => array:2 [ "nombre" => "Patricia" "apellidos" => "De Sequera" ] 3 => array:2 [ "nombre" => "Mayra" "apellidos" => "Ortega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301539" "doi" => "10.1016/j.nefro.2016.09.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301539?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300299?idApp=UINPBA000064" "url" => "/20132514/0000003700000001/v1_201703230033/S2013251417300299/v1_201703230033/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251417300081" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2016.09.012" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "257" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:105-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4234 "formatos" => array:3 [ "EPUB" => 351 "HTML" => 3309 "PDF" => 574 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "ANCA-negative idiopathic pulmonary fibrosis developed into ANCA-positive rapidly progressive glomerulonephritis after 12 years follow up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "105" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fibrosis pulmonar idiopática ANCA negativa desarrollada en la glomerulonefritis de evolución rápida en ANCA positiva después de 12 años de seguimiento" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 485 "Ancho" => 1861 "Tamanyo" => 212865 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging studies of the lungs and microscopic slides of renal tissue. (A) Chest X ray – Interstitial reticular fibrotic infiltration with honey comb appearance over both lungs. (B) Non-contrast computed tomography of the chest shows pulmonary fibrosis with cystic change in bilateral lung fields, with lower lung zones predominance. Infiltrates and ground-glass opacity in bilateral peri-hilar regions were also noted. (C) Renal biopsy (400×) – Glomeruli showed mesoangiocapillary proliferation and segmental sclerosis. 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González-Arregoces, Igor Romainoik, Santiago Mariño, Cristina Lucas, Elena Monfá, George Stefan, Benjamin de León, Mario Prieto" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Aránzazu" "apellidos" => "Sastre" "email" => array:1 [ 0 => "aranchasastre@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Jose E." "apellidos" => "González-Arregoces" ] 2 => array:2 [ "nombre" => "Igor" "apellidos" => "Romainoik" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Mariño" ] 4 => array:2 [ "nombre" => "Cristina" "apellidos" => "Lucas" ] 5 => array:2 [ "nombre" => "Elena" "apellidos" => "Monfá" ] 6 => array:2 [ "nombre" => "George" "apellidos" => "Stefan" ] 7 => array:2 [ "nombre" => "Benjamin" "apellidos" => "de León" ] 8 => array:2 [ "nombre" => "Mario" "apellidos" => "Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Peritonitis causada por <span class="elsevierStyleItalic">Pantoea agglomerans</span> en diálisis peritoneal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pantoea agglomerans</span> is a germ that infrequently causes peritonitis in peritoneal dialysis patients. Let us look at the case of a peritoneal dialysis patient who presented with peritonitis due to this germ.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 83-year-old man living in an urban environment, who carried out basic daily activities independently and who had been on outpatient peritoneal dialysis with 4 daily exchanges for 4 years. The cause of the chronic kidney disease was nephroangiosclerosis, with no other comorbidity. The patient was well adapted to the dialysis and had no adequacy, ultrafiltration or fluid overload problems. However, he had suffered 6 episodes of peritonitis. Peritonitis is defined as peritoneal inflammation caused by microorganisms, with the presence of cloudy peritoneal fluid, a count of more than 100<span class="elsevierStyleHsp" style=""></span>leukocytes/μl with more than 50% polymorphonuclear cells. It remains the most significant complication deriving from the dialysis technique itself. It is generally caused by Gram-positive skin bacteria such as <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and <span class="elsevierStyleItalic">Staphylococcus aureus</span>, or by enterobacteria and fungi. Prevention is the fundamental weapon, acting on the routes by which microorganisms enter the peritoneal cavity: peritoneal access, connection systems, dialysis solutions and examinations that enable infection. The germs identified in the previous peritonitis episodes were gram-positive. The patient had been retrained in the performance of the dialysis technique on multiple occasions to try to prevent new episodes and it had been proven that he was not a nasal carrier of <span class="elsevierStyleItalic">Staphylococcus aureus</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient came to the dialysis unit complaining of abdominal pain and with a cloudy peritoneal effluent, detected in the last exchange. He had not had fever, nausea, or intestinal transit alterations. His count was 560<span class="elsevierStyleHsp" style=""></span>leukocytes/μl with 80% polymorphonuclear cells. Examination revealed signs of peritoneal irritation. Gram stain and cultures were taken. Treatment was started with intraperitoneal cefazolin and tobramycin. Since the patient's condition was unchanged, he was monitored as an outpatient. At the 48-h follow-up, he showed a clinical improvement with clear peritoneal fluid, a peritoneal count below 100<span class="elsevierStyleHsp" style=""></span>leukocytes/μl, and the culture received tested positive for <span class="elsevierStyleItalic">Pantoea agglomerans</span>.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pantoea agglomerans</span> (formerly known as <span class="elsevierStyleItalic">Enterobacter agglomerans</span> and previously as <span class="elsevierStyleItalic">Erwinia agglomerans</span>) is a gram-negative bacillus from the <span class="elsevierStyleItalic">Enterobacteriaceae</span> family which basically causes nosocomial infections in immunocompromised patients,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> our elderly patient and in dialysis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Species of the <span class="elsevierStyleItalic">Pantoea</span> genus are generally isolated from soil, plants, fruits and vegetables, but they have also been found in human and animal faeces. In our case, there is no evidence of contact with plants or animals, but it is possible that there were deficiencies in washing hands and making connections after touching fruit.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As a pathogen, it has traditionally been described as a causative factor of localised infections such as synovitis, post-traumatic arthritis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> due to plant thorns or splinters, as well as cases of peritonitis in dialysis patients, since it can grow in glucose-rich media (gardener's peritonitis?)<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3–5</span></a> and in carriers of invasive devices, in the paediatric population it can cause sepsis<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> and it has also been cultivated in bile samples from patients with cholangitis and choledocholithiasis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was kept on tobramycin treatment for 14 days, showing an excellent sensitivity to cephalosporins, aminoglycosides and ciprofloxacin.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following this new peritonitis episode, after identifying errors in performing the exchange during retraining sessions and due to his advanced age, we decided to transfer the patient to carer-assisted automated peritoneal dialysis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sastre A, González-Arregoces JE, Romainoik I, Mariño S, Lucas C, Monfá E, et al. Peritonitis causada por <span class="elsevierStyleItalic">Pantoea agglomerans</span> en diálisis peritoneal. Nefrologia. 2017;37:108–109.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacteriemia por <span class="elsevierStyleItalic">Pantoea agglomerans</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Marcos Sánchez" 1 => "A.I. Muñoz Ruiz" 2 => "M.J. Martín Barranco" 3 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 59 | 36 | 95 |
| 2024 September | 60 | 28 | 88 |
| 2024 August | 82 | 53 | 135 |
| 2024 July | 69 | 34 | 103 |
| 2024 June | 88 | 41 | 129 |
| 2024 May | 75 | 35 | 110 |
| 2024 April | 60 | 36 | 96 |
| 2024 March | 48 | 27 | 75 |
| 2024 February | 48 | 36 | 84 |
| 2024 January | 39 | 24 | 63 |
| 2023 December | 33 | 27 | 60 |
| 2023 November | 50 | 28 | 78 |
| 2023 October | 50 | 26 | 76 |
| 2023 September | 30 | 27 | 57 |
| 2023 August | 53 | 29 | 82 |
| 2023 July | 52 | 32 | 84 |
| 2023 June | 43 | 19 | 62 |
| 2023 May | 65 | 45 | 110 |
| 2023 April | 46 | 26 | 72 |
| 2023 March | 62 | 24 | 86 |
| 2023 February | 39 | 22 | 61 |
| 2023 January | 57 | 25 | 82 |
| 2022 December | 57 | 36 | 93 |
| 2022 November | 55 | 26 | 81 |
| 2022 October | 47 | 35 | 82 |
| 2022 September | 53 | 41 | 94 |
| 2022 August | 58 | 47 | 105 |
| 2022 July | 56 | 47 | 103 |
| 2022 June | 60 | 41 | 101 |
| 2022 May | 75 | 32 | 107 |
| 2022 April | 78 | 62 | 140 |
| 2022 March | 57 | 44 | 101 |
| 2022 February | 46 | 46 | 92 |
| 2022 January | 52 | 32 | 84 |
| 2021 December | 63 | 40 | 103 |
| 2021 November | 57 | 44 | 101 |
| 2021 October | 54 | 28 | 82 |
| 2021 September | 62 | 31 | 93 |
| 2021 August | 56 | 44 | 100 |
| 2021 July | 60 | 30 | 90 |
| 2021 June | 46 | 28 | 74 |
| 2021 May | 57 | 50 | 107 |
| 2021 April | 129 | 57 | 186 |
| 2021 March | 88 | 29 | 117 |
| 2021 February | 84 | 31 | 115 |
| 2021 January | 58 | 20 | 78 |
| 2020 December | 46 | 19 | 65 |
| 2020 November | 58 | 18 | 76 |
| 2020 October | 52 | 23 | 75 |
| 2020 September | 46 | 10 | 56 |
| 2020 August | 45 | 10 | 55 |
| 2020 July | 62 | 15 | 77 |
| 2020 June | 63 | 15 | 78 |
| 2020 May | 58 | 16 | 74 |
| 2020 April | 45 | 19 | 64 |
| 2020 March | 44 | 19 | 63 |
| 2020 February | 45 | 22 | 67 |
| 2020 January | 82 | 23 | 105 |
| 2019 December | 48 | 25 | 73 |
| 2019 November | 54 | 21 | 75 |
| 2019 October | 69 | 25 | 94 |
| 2019 September | 42 | 15 | 57 |
| 2019 August | 37 | 26 | 63 |
| 2019 July | 44 | 22 | 66 |
| 2019 June | 59 | 15 | 74 |
| 2019 May | 45 | 30 | 75 |
| 2019 April | 90 | 36 | 126 |
| 2019 March | 45 | 21 | 66 |
| 2019 February | 35 | 15 | 50 |
| 2019 January | 54 | 35 | 89 |
| 2018 December | 127 | 32 | 159 |
| 2018 November | 162 | 21 | 183 |
| 2018 October | 175 | 21 | 196 |
| 2018 September | 92 | 22 | 114 |
| 2018 August | 68 | 16 | 84 |
| 2018 July | 63 | 14 | 77 |
| 2018 June | 78 | 13 | 91 |
| 2018 May | 70 | 17 | 87 |
| 2018 April | 103 | 8 | 111 |
| 2018 March | 71 | 11 | 82 |
| 2018 February | 86 | 9 | 95 |
| 2018 January | 88 | 8 | 96 |
| 2017 December | 91 | 6 | 97 |
| 2017 November | 53 | 14 | 67 |
| 2017 October | 37 | 8 | 45 |
| 2017 September | 42 | 10 | 52 |
| 2017 August | 43 | 5 | 48 |
| 2017 July | 41 | 4 | 45 |
| 2017 June | 51 | 6 | 57 |
| 2017 May | 50 | 12 | 62 |
| 2017 April | 44 | 6 | 50 |
| 2017 March | 45 | 5 | 50 |
| 2017 February | 6 | 1 | 7 |
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