When Skin Flora Turns Pathogenic: Kocuria-Associated Peritonitis Leading to Peritoneal Dialysis Catheter Removal

Introduction: Kocuria species are Gram-positive coccoid bacteria, part of normal skin and oral flora, typically considered nonpathogenic. However, rare cases of Peritoneal dialysis (PD)-associated peritonitis caused by Kocuria have been reported, often leading to relapsing infections and ultimately necessitating PD catheter removal and conversion to hemodialysis. Case Description: We present a case of a 57-year-old woman with End stage renal disease (ESRD) on PD for 4 years, with recurrent peritonitis. Three months prior, she developed abdominal pain and cloudy effluent; cultures grew Kocuria species. She was treated with 4 weeks of intraperitoneal vancomycin, with resolution of symptoms and negative repeat cultures. However, 3–4 weeks after completing antibiotics, she again noted cloudy effluent and abdominal pain. PD fluid culture tested positive again for Kocuria species. Abdominal imaging showed no abscess or fluid collection. After multidisciplinary discussion and as per patient preference, the decision was made to retain the PD catheter and re-treat with 4 more weeks of IP vancomycin. The patient showed clinical improvement but experienced a recurrence of symptoms 4 weeks after completing treatment. Given recurrent peritonitis episodes, the decision was made to remove the PD catheter. She was transitioned to hemodialysis. Discussion: PD peritonitis is a well-known complication of peritoneal dialysis and a common cause of modality failure. While Kocuria is not a typical pathogen in PD-related infections, literature suggests a notable association with relapsing peritonitis and eventual catheter removal. This case underscores the potential for Kocuria to act as a persistent pathogen in PD patients, possibly due to biofilm formation on the catheter. Awareness of this association may inform earlier consideration of catheter removal in cases of relapsing infection due to Kocuria species. We report a case of Kocuria causing PD peritonitis leading PD catheter removal. This case adds to growing evidence that Kocuria species, though typically benign, can lead to serious PD complications requiring catheter removal.