Peritoneal dialysis-related peritonitis from Burkholderia pseudomallei infection (Melioidosis) of northeast Thailand

Abstract

Objectives: Melioidosis is an uncommon cause of peritonitis in patients with end-stage renal disease who are receiving continuing peritoneal dialysis. This study aims to investigate the prevalence and outcome of peritoneal dialysis-related peritonitis due to Burkholderia pseudomallei infection. Materials and Methods: A retrospective cohort study of melioidosis infection between 2018 and 2022, peritoneal dialysis-related peritonitis in cases with end-stage renal failure was collected. The patients’ demographics, clinical characteristics, and treatments were described. Results: Of the 194 cases diagnosed with peritoneal dialysis-related peritonitis, there were 7 patients (3.6%) with melioidosis peritonitis. The patients’ mean age was 51.1 ± 9.44 years old, range of 40–65. Diabetes (5 cases, 71.4%) and hypertension (7 cases, 100%) were the most common co-morbidities. Six cases (85.7%) had fever, 5 (71.4%) had hazy dialysate, and everyone had abdominal pain as clinical signs. Associated septicemia was observed in 5 (71.4%) cases. As part of their antibiotic therapy, meropenem was given to 1 (14.3%) and ceftazidime to 6 (85.7%) cases. Six cases (85.7%) received intravenous antibiotics, whereas 1 (14.3%) case received both intravenous and intraperitoneal routes. The catheters were removed; then, hemodialysis sessions of 5 (71.4%) cases were initiated. Hemodialysis mode was switched permanently in 3 (42.9%) cases and temporarily in one case, thereafter, peritoneal dialysis was resumed. 3 (42.9%) cases died. No significant relations were found about risk factors between survivor and non-survivor group (P < 0.05). Conclusion: Peritoneal dialysis-related peritonitis due to melioidosis is uncommon. However, it may be accompanied by catheter loss and can be lethal if untreated as systemic melioidosis.