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

Table 2

All reported cases of Achromobacter spp. peritonitis-bacterial sensitivities, antibiotics selection with duration, and outcomes.

Case	Antimicrobial sensitivities	Antibiotics utilized	Antibiotic duration	Outcomes
Bacterial peritonitis secondary to peritoneal dialysis
1 [8]	S: ampicillin, carbenicillin, colistin, smz/tmp	Carbenicillin IV	NR	Cure
	R: AG, tetracycline
	I: cephalothin
2 [5]	S: colistin, moxalactam, cefamandole	Moxalactam ^∗	Likely 15 days	Deceased
	R: piperacillin, azlocillin, ceftazidime, cefoperazone, novobiocin, minocycline	Noxytiolin IP
	I: rifampin, rosoxacin
3 [53]	S: smz/tmp, AG, carbenicillin	Tobramycin IP	3 days	Relapse
		Cephalothin IP
	R: ampicillin, cefamandole, cefoxitin, cephalothin, tetracycline, chloramphenicol	smz/tmp IP	10 days	Cure
4 [54, 55]	R: AG	Vancomycin IP	1 dose	Deterioration
		Gentamicin IP
	Complete sensitivity profile was not available. Initial response to gentamicin was documented by El-Shahawy, et al. [46].	Gentamicin IP	NR	Deterioration
		Ciprofloxacin PO
		Piperacillin IV	7 days	Cure
5 [55]	S: ofloxacin	Vancomycin IP	3 days	Cure
		Ceftazidime IV
	R: AG, aztreonam, cefazolin, cefotaxime, cefoxitin, ceftriaxone, ceftazidime, cefuroxime, ciprofloxacin, imipenem, piperacillin, smz/tmp	Ceftazidime IV	14 days
		Ofloxacin PO
7 [56]	S: P/T	Cefazolin IP	3 days	Cure
		Tobramycin IP
	R: ampicillin, cephalothin, ceftriaxone, AG, ciprofloxacin, smz/tmp	Amikacin IP	3 days
		Ceftazidime IP
		P/T IV	21 days
8 [56]	S: piperacillin, ticarcillin, ceftriaxone, ceftazidime, smz/tmp	Cefazolin IP	3 days	Cure
		Tobramycin IP
	R: AG	Amikacin IP	5 days
		Ceftazidime IP
		P/T IV	21 days
10 [49]	S: ciprofloxacin, imipenem	Vancomycin IP	NR	Cure
		Ceftazidime IP
		Ciprofloxacin PO
	R: ceftazidime, smz/tmp	Ceftazidime IP
		Amikacin IP
		smz/tmp PO
		Imipenem IP
		Ciprofloxacin PO
11 [57]	S: imipenem, P/T	Ceftazidime IP	1 dose	Cure
		Cefazolin IP
	R: cefotaxime, AG	Ciprofloxacin PO	NR
		Imipenem IV	3 doses
	I: ciprofloxacin	Imipenem IP	30 days
		Ciprofloxacin PO	10 days
12 [58]	Complete sensitivity profile was not reported but ampicillin/sulbactam, ciprofloxacin and cefepime were definitive therapies	Ceftazidime IV	NR	Cure
		Cefazolin IV
		amp/sulb IV	7 days
		Ciprofloxacin^∗	2 days
		Cefepime^∗	7 days
13 [59]	S: ceftazidime, imipenem, meropenem, levofloxacin, piperacillin	Vancomycin IP	7 days	Deterioration
		Amikacin IP
	R: NR	Imipenem/cil IP	7 days
		P/T IP
		Ceftazidime	NR	Deceased
		Cefazolin
		Imipenem/cil
		Vancomycin
		Imipenem/cil IP	NR
		Vancomycin IP
		Imipenem/cil IV	29 days
		Vancomycin IV
14 [60]	S: ceftazidime, cefepime, sulfonamide, quinolones, carbapenem, P/T	Ciprofloxacin PO	14 days	Cure
	R: NR
15 [50]	Unable to obtain due to lack of article access	Cefazolin IP	3 days	Cure
		Ceftazidime IP
		Ceftazidime IP	4 days
16 [43]	S: ciprofloxacin, others NR	Ciprofloxacin^∗	NR	Cure
	R: NR
17 [14]	S: amp/sulb, smz/tmp, carbapenem, cephoperazone/sulbactam, ceftazidime, P/T, tigecycline	Cephalosporin PO	14 days	Relapse
	R: 1st generation cephalosporin, ciprofloxacin	Cefazolin IP	7 days	Cure
		Ceftazidime IP
		amp/sulb PO	14 days
18 [52]	S: P/T, ceftazidime, imipenem	Ceftazidime IP	NR	Replase
		Cefazolin IP
	R: ciprofloxacin, cefepime	Imipenem/cil^∗	14 days
		Imipenem IV	14 days	Replase
		Ceftazidime IV
		Imipenem IV	14 days	Cure
		Ceftazidime IV
Sponteneous bacterial peritonitis
6 [12]	S: amox/clav, ceftazidime, P/T, imipenem, meropenem, cotrimoxazole	Ceftriaxone IV	10 days	Cure
	I: cefotaxime, ceftriaxone, ofloxacin, ciprofloxacin
	R: AG, aztreonam, cefazolin, cefuroxime
9 [13]	S: NR	P/T IV	Few hours	Deceased (few hours later)
	R: cefotaxime, aztreonam, AG, ciprofloxacin
Percutaneous endoscopic gastrostomy tube-associated peritonitis
19	S: P/T (≤2/4), smz/tmp (≤0.5/9.5), meropenem (0.25)	P/T IV	4 days	Deterioration
	R: aztreonam (16), cefepime (16), gentamicin (8)	Levofloxacin IV	2 days	Deterioration
		Metronidazole IV
	I: amikacin (32), levofloxacin (4), tobramycin (8)	Linezolid IV	7 days	Deterioration
		Doxycycline IV
		Meropenem IV	4 days	Adverse reaction
		Linezolid IV
		Meropenem IV	2 days	Transferred to UK
		P/T IV	2 days	Adverse reaction
		Vancomycin IV
		Cefepime IV	4 days	Deterioration
		Vancomycin IV
		Metronidazole IV
		P/T IV	5 days	Deterioration
		Meropenem IV	4 days	Deceased
		Vancomycin IV

In case 2, the duration of treatment was not clearly reported but was likely 15 days; route of moxalactam was unreported. Case 12 did not report route of ciprofloxacin and cefepime; total of 20 days of antibiotics were administered as patient had presented with 5^th episode of peritonitis; subsequently, hemodialysis was initiated. Case 13 reported total of 48 days of antimicrobial treatment. Case 16 did not report full culture and sensitivities, route of ciprofloxacin and total duration of the treatment. Case 18 does not report route of imipenem/cilastatin. Abbreviations: S = Sensitive, R = resistant, I = intermediate, smz/tmp = sulfamethoxazole/ trimethoprim, P/T = piperacillin/tazobactam, amp/sulb = ampicillin/sulbactam, amox/clav = amoxicillin/clavulanate, cil = cilastatin, AG = aminoglycosides, IV = intravenous, IP = intraperitoneal, PO = oral, NR = not reported.