Peritoneal Dialysis-Associated Peritonitis Caused by Achromobacter xylosoxidans: A Case Report and Literature Review.

Achromobacter xylosoxidans is a gram-negative bacterium that is responsible for rare peritonitis associated with peritoneal dialysis (PD). We present a case of a 64-year-old woman with a medical history of end-stage renal disease undergoing PD who was admitted to the emergency department with abdominal pain and nausea. Physical examination and laboratory studies revealed peritoneal signs and laboratory abnormalities consistent with peritonitis. Intraperitoneal catheter dysfunction was identified and subsequently resolved via laparoscopy. Following a peritoneal fluid culture, A xylosoxidans was identified, leading to the initiation of intraperitoneal meropenem treatment. After an initial improvement, the patient developed an ileus and recurrent abdominal symptoms, and further peritoneal cultures remained positive for A xylosoxidans. Subsequent treatment included intravenous meropenem and vancomycin for Clostridium difficile colitis. Owing to the high likelihood of biofilm formation on the PD catheter by A xylosoxidans, the catheter was removed, and the patient transitioned to hemodialysis. Intravenous meropenem was continued for 2 weeks post-catheter removal. This case highlights the challenges in managing recurrent peritonitis in PD patients caused by multidrug-resistant A xylosoxidans. A high index of suspicion, appropriate microbiological identification, and targeted intraperitoneal and systemic antibiotic treatment, along with catheter management, are crucial in achieving a favorable outcome in such cases.

Epidemiology and Pattern of Orthopedic Trauma in Children and Adolescents: Implications for Injury Prevention.

BACKGROUND: Orthopedic injuries are prevalent in children and can result in hospitalization and damage. The number of accidental injuries among children increases every year, leading to a huge burden on communities and health institutions. AIM: This study aimed to assess the epidemiological pattern of orthopedic trauma among children and adolescents in Abha, Saudi Arabia. METHODS: A retrospective record-based study was carried out to investigate the epidemiological pattern of orthopedic trauma among children and adolescents treated at Abha Maternity and Children Hospital in Saudi Arabia, a traumatic center for pediatric patients. The study covered all children and adolescents treated at the hospital for orthopedic trauma. The parents of the children and adolescents were called to get their consent to participate in the study. The following data were extracted from the medical files: personal information, medical history, trauma-related details, management, hospitalization, and complications. RESULTS: A total of 295 children and adolescents were included. The mean ± standard deviation age was 6.8 ± 3.1 years old (range 1 month to 13 years). Of the patients, 186 (63.1%) were male. The most reported causes of traumas were fall from height (48.1%) and injury while playing (19.7%). The most affected body parts included the forearm (22.4%), head (21.7%), thigh (20%), and leg (10.8%). The vast majority of the children and adolescents (87.1%) had no complications. CONCLUSION: The current study revealed that pediatric orthopedic injuries are not rare, and there is a higher likelihood of injuries among young male children. Fall from height and play-associated injuries are the most frequent causes.