title: Streptococcal PD peritonitis--a 10-year review of one centre's experience.
abstract: 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.
authors.affiliation: University Health Network and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Shukla
authors.forename: Zita
authors.initials: Z
authors.lastname: Abreu
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors