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Kidney Diseases

Alcaligenes xylosoxidans

03/04/2011

Question:

My son is on peritoneal dialysis and has contracted peritonitis. The doctors told me that his culture grew a bug called Alcaligenes xylosoxidans. I want to know what could have caused this and how is it treated? I was always careful to take all the necessary precautions of keeping my hands washed and sanitized, made sure that he was clean and that nothing touched the sterile areas. I really don`t understand this!

Answer:

This bacterium is an unusual water-borne organism that causes healthcare-associated infections and bacteremia in immunocompromised patients with indwelling catheters. It has a tendency to contaminate liquids. It is resistant to most antibiotics. It has been observed in situations in which saline or heparin was withdrawn from multiple use vials, use of unlabeled, prefilled syringes, poor hand hygiene, lack of glove use, and artificial fingernails.

More information:

1. Am J Nephrol. 2001 Nov-Dec;21(6):502-6.

CAPD-associated peritonitis caused by Alcaligenes xylosoxidans sp. xylosoxidans.

Tang S, Cheng CC, Tse KC, Li FK, Choy BY, Chan TM, Lai KN. Department of Medicine, Queen Mary Hospital, University of Hong Kong, People's Republic of China.

Erratum in:

Am J Nephrol 2002 Jan-Feb;22(1):90.

Abstract

Alcaligenes xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). Peritonitis caused by A. xylosoxidans usually carries a poor prognosis because of the pathogen's virulence and its universal resistance to most antimicrobial agents. Even after early Tenckhoff catheter removal, the transport property of the peritoneum is often irreversibly damaged, leading to permanent technique failure. We report 2 patients with CAPD-associated peritonitis due to A. xylosoxidans sp. xylosoxidans who were successfully cured with a combination of piperacillin and tazobactam. One of them subsequently returned uneventfully to CAPD.

2. Am J Nephrol. 1998;18(5):452-5.

Peritoneal dialysis-associated peritonitis caused by Alcaligenes xylosoxidans.

El-Shahawy MA, Kim D, Gadallah MF. Division of Nephrology, University of Southern California School of Medicine, Los Angeles, CA 90033, USA. elshahaw@hsc.usc.edu

Abstract

Despite significant progress to decrease its incidence, peritonitis remains the main source of morbidity and treatment failure in patients on continuous ambulatory peritoneal dialysis (CAPD). The majority of cases of peritonitis result from infection with aerobic gram-positive (Staphylococcus epidermidis and Staphylococcus aureus), or gram-negative organisms. Less common organisms that are also reported include anaerobic bacteria, fungi, and mycobacteria, which collectively account for less than 10% of isolates cultured. We report a case of peritoneal dialysis-associated peritonitis, and review the literature on peritonitis caused by Alcaligenes species. Alcaligenes xylosoxidans is a nonfermenting gram-negative rod and opportunistic pathogen that is motile with peritrichous flagella. The clinical features and microbiological data of our case, as well as the other previously reported cases of peritonitis caused by Alcaligenes species show no particular pattern of peritoneal dialysate cell count. However, the rate of recurrence of peritonitis is characteristically high. The cause of such a high rate of recurrence of peritonitis is probably a reflection of the predilection of Alcaligenes species to cause infection in the 'sicker' patients, and the almost universal resistance of this species to most antimicrobial agents. We, therefore, recommend that catheter removal be undertaken as early as the identification of the organism is made. Whether patients should be allowed to return to CAPD after recovery is a more difficult question. We suggest that a reevaluation of the patient's overall status be undertaken, including personal hygiene, exchange technique, presence of diabetes mellitus, malnutrition, and/or other factors that may render the patient more prone to infection with opportunistic pathogens.

3. There is a more recent report of successful treatment:

Peritoneal Dialysis International, Vol. 27, pp. 596–599

Successful Treatment of Alcaligenes xylosoxidans in Automated Peritoneal Dialysis-Related Peritonitis

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University