Acinetobacter Peritonitis in CAPD

A 54 year old lady with chronic kidney disease stage 5 on CAPD presented to us with peritonitis. This was her second episode of peritonitis. The previous episode was a year before and was culture negative. The present culture grew Acinetobacter which was sensitive to aminoglycosides, fluoroquinolones, fourth generation cephalosporins and carbapenems. We treated her with Imipenem for 4 weeks and the peritonitis resolved. A month later she developed peritonitis again which was culture negative and carbapenem resistant requiring CAPD catheter removal for refractory peritonitis. Acinetobacter is an uncommon cause of gram negative peritonitis with a tendency for antibiotic resistance warranting catheter removal as highlighted by this case.