Serratia marcescens peritonitis in a continuous ambulatory peritoneal dialysis patient: A case report and literature review
Abstract
Introduction: Peritonitis caused by Serratia marcescens in patients undergoing continuous ambulatory peritoneal dialysis is a rare but clinically significant condition. As an opportunistic gram-negative pathogen with notable genomic plasticity and biofilm-forming capacity, Serratia marcescens frequently leads to catheter loss and treatment failure. This case highlights the diagnostic challenges, antibiotic management strategy, and the clinical course leading to catheter removal in a high-risk continuous ambulatory peritoneal dialysis patient.
Case presentation: A 61-year-old woman with stage 5 chronic kidney disease on continuous ambulatory peritoneal dialysis for four years presented with abdominal pain, nausea, fever (38.3°C), and cloudy dialysate. Dialysate white blood cell count was markedly elevated at 5600/mm³ with neutrophil predominance. Peritonitis was diagnosed per International Society for Peritoneal Dialysis criteria. Peritoneal fluid culture grew Serratia marcescens susceptible to meropenem, piperacillin/tazobactam, ciprofloxacin, ceftazidime, imipenem, and trimethoprim-sulfamethoxazole, but resistant to amikacin, amoxicillin-clavulanate, and ampicillin. Empirical therapy with piperacillin/tazobactam and teicoplanin was replaced by intravenous plus intraperitoneal meropenem combined with teicoplanin. Despite a partial decrease in dialysate cell count, persistent fever and inadequate acute phase reactant response led to catheter removal after approximately 21…
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