title: Streptococcus bovis peritonitis complicating peritoneal dialysis--a review of 10 years' experience.
abstract: OBJECTIVE
  An association of Streptococcus bovis bacteremia with carcinoma of colon has been reported, but data regarding peritoneal dialysis (PD) peritonitis caused by S. bovis is scarce. In this study, we examined the clinical characteristics, associations, and outcomes of this disease entity.
  
  
  METHODS
  The case records of patients with S. bovis PD peritonitis presenting to 2 renal centers between January 2000 and September 2010 were reviewed. Clinical features and outcomes were identified and analyzed.
  
  
  RESULTS
  Of cultures from 23 episodes of S. bovis peritonitis in 20 patients (1.28% of all peritonitis episodes at our center), 19 (82.6%) showed S. bovis alone, and 4 (17.4%) showed mixed growth. In 7 episodes, the S. bovis was moderately resistant to penicillin G. Rates of resistance to clindamycin and erythromycin were 43.5% and 47.8% respectively. In 18 episodes (78.3%), a primary response was achieved with a first-generation cephalosporin and an aminoglycoside. In 4 episodes, a secondary response was achieved after a switch from cephalosporin to vancomycin, and in 1 episode with mixed growth, the Tenckhoff catheter had to be removed. Repeat peritonitis occurred in 3 patients at a mean of 50.0 months (range: 24.2 - 83.1 months). Of the 20 patients of S. bovis peritonitis, 10 (50%) underwent either a barium enema or a colonoscopy. One patient had history of colonic carcinoma 2 years before the peritonitis, and a subsequent work-up revealed no recurrence. Three patients had diverticulosis, and one had a concomitant sigmoid polyp. Findings in the other 6 patients were normal. No colorectal malignancy had developed in the remaining 10 patients after a mean follow-up of 76.6 months (range: 0.8 - 125.1 months).
  
  
  CONCLUSIONS
  Outcomes in S. bovis PD peritonitis were favorable, and an association with colorectal cancer was not found in our patients. Routine colonoscopy in these patients remains controversial and should be individualized.
authors.affiliation: Division of Nephrology, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, PR China.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: To
authors.forename: Terence P S
authors.initials: TP
authors.lastname: Yip
authors.forename: Sing Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Kar Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D016985:Streptococcus bovis / Q000302:isolation & purification*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents