NDT Advance Access originally published online on September 27, 2006
Nephrology Dialysis Transplantation 2006 21(12):3545-3549; doi:10.1093/ndt/gfl407
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Streptococcal PD peritonitis—a 10-year review of one centre's experience
University Health Network and University of Toronto, Toronto, Ontario, Canada
Correspondence and offprint requests to: Joanne M. Bargman, MD, FRCPC, 200 Elizabeth Street 8N-840, Toronto, Ontario M5G 2C4, Canada. Email: joanne.bargman{at}uhn.on.ca
Background. Detailed descriptive studies focusing on streptococcal peritonitis in patients on peritoneal dialysis are lacking. Most of the current information is available through isolated case reports.
Methods. We conducted a retrospective analysis of our peritoneal dialysis (PD) peritonitis database over the last decade to study the clinical profile and treatment outcomes of streptococcal peritonitis.
Results. A total of 68 patients (age: 57.12 ± 16.6 years; male: 58.7%) with 104 episodes of streptococcal peritonitis (11.7% of total peritonitis) were identified. Of the patients, 18 (26.4%) were considered immunocompromised [failed renal transplant, systemic lupus erythematosus (SLE)] and 28 (41.1%) had diabetes.
Streptococcus viridans accounted for the majority (94 episodes: 90.3%) of the streptococcal peritonitis. One patient developed S. viridans peritonitis after dental cleaning without antibiotic prophylaxis. Two (1.9%) infections with S. agalactiae and S. bovis each and seven (6.7%) with non-haemolytic Streptococcus were noted. Three patients had hospital-acquired infection. Twenty-six (25%) episodes needed 8 ± 5.9 days of hospitalization.
Concurrent infection with two organisms accounted for 17 (16.3%) episodes. Cefazolin (71) and vancomycin (29) were the primary antibiotics used for the treatment. Five episodes needed two antibiotics and one patient required antifungal treatment.
A third of the patients (33.3%) had peritonitis that resolved slowly, although the majority of those (94%) did ultimately resolve with antibiotics alone. Five (4.8%) episodes required removal of the PD catheter. Three of them were associated with dual infections (one each with yeast, Stenotrophomonas and Enterococcus). Relapse occurred in eight (7.6%) episodes, and 11 (10.5%) recurred over the period from 4 weeks to 6 months after treatment.
Conclusions. Streptococci remain a significant cause of PD peritonitis. Viridans strep is the primary subtype responsible. Isolated infections with these organisms are associated with slower response, good outcome and higher rates of recurrence.
Keywords: PD peritonitis; peritoneal dialysis; streptococcal peritonitis