Bacterial peritonitis is a key complication of Peritoneal Dialysis (PD) and a preventable cause of withdrawal from PD treatment. Infection generally arises from contamination with skin commensals during handling of the dialysis delivery system or from translocation of gastrointestinal organisms and more rarely from an environmental organism. Herein, we report the case of a 73-year-old admitted for PD-related peritonitis due to with an associated environmental exposure from a domestic plumbing issue. We describe the presentation, case, and antibiotic regimen progression from empiric therapy of ceftazidime and vancomycin IP to ciprofloxacin. We acknowledge the importance of performing laboratory sensitivities given the high antibiotic resistance of the genus. We offer that nephrologists should consider as a potential causative organism of peritonitis, especially when initial or further history reveals exposure to potentially contaminated water.
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