First Documented Case of Percutaneous Endoscopic Gastrostomy (PEG) Tube-Associated Bacterial Peritonitis due toAchromobacterSpecies with Literature Review

Abstract

Introduction. Achromobacterspecies (spp.) peritonitis has seldom been identified in medical literature. Scarce cases ofAchromobacterperitonitis described previously have been correlated with peritoneal dialysis and more sparingly with spontaneous bacterial peritonitis.Achromobacterexhibits intrinsic and acquired resistance, especially in chronic infections, to most antibiotics. This article conducts a literature review of all previously reportedAchromobacterspp. peritonitis and describes the first reported case ofAchromobacterperitonitis as a complication of percutaneous endoscopic gastrostomy (PEG) tube placement.Discussion.Achromobacterperitonitis as a complication of PEG-tube placement has not been previously reported. In our patients’ case, the recently placed PEG-tube with ascitic fluid leakage was identified as the most plausible infection source. Although a rare bacterial peritonitis pathogen,Achromobactermay be associated with wide antimicrobial resistance and unfavorable outcomes.Conclusion.No current guidelines provide significant guidance on treatment of PEG-tube peritonitis regardless of microbial etiology. Infectious Disease Society of America identifies various broad-spectrum antibiotics targeting nosocomial intra-abdominal coverage; some of these antimicrobial selections (such as cefepime and metronidazole combination) may yet be inadequate for widely resistantAchromobacterspp. Recognizably, the common antibiotics utilized for spontaneous bacterial peritonitis, i.e., third generation cephalosporins and fluoroquinolones, to whichAchromobacteris resistant and variably susceptible, respectively, would be extensively insufficient. Piperacillin/tazobactam (P/T) and carbapenem were identified to provide the most reliable coveragein vitro; clinically, 5 out of the 8 patients who received either P/T or a carbapenem, or both, eventually experienced clinical improvement.