Viêm phúc mạc và nhiễm khuẩn huyết do Ralstonia mannitolilytica ở bệnh nhi thẩm phân phúc mạc: Báo cáo một trường hợp hiếm gặp

Abstract

Peritonitis is a well-recognized complication of peritoneal dialysis (PD), commonly caused by Gram-positive or Gram-negative organisms originating from the gastrointestinal or urinary tract. Rarely, atypical pathogens may be implicated. We describe a case of peritonitis and sepsis due to Ralstonia mannitolilytica in a 6-year-old girl who had been undergoing PD for over three years without prior episodes of peritonitis. To our knowledge, this is the first documented case of Ralstonia-associated peritonitis in a pediatric PD patient in Vietnam. The patient presented with abdominal pain, fever, and cloudy dialysate. Peritoneal fluid and blood cultures grew Ralstonia mannitolilytica, which demonstrated resistance to standard empirical therapy. Although PD catheter removal was considered, technical limitations associated with the patient’s low body weight rendered conversion to hemodialysis unfeasible. The patient was subsequently treated with a revised antibiotic regimen, including intraperitoneal ciprofloxacin, resulting in gradual clinical improvement. Ralstonia species are waterborne, opportunistic Gram-negative pathogens, and should be considered in PD-related infections, especially in immunocompromised pediatric patients.