Viridans streptococci in peritoneal dialysis peritonitis: clinical courses and long-term outcomes.
BACKGROUND
The clinical courses and long-term outcomes of viridans streptococcus (VS) peritoneal dialysis (PD) peritonitis remain unclear.


METHODS
We conducted a retrospective analysis of all PD patients in a single center with gram-positive cocci (GPC) peritonitis between 2005 and 2011, and divided them into 3 groups: VS, other streptococci and other GPC (apart from VS). Clinical characteristics and outcomes of the VS group were compared with the other streptococci and other GPC groups, with prognostic factors determined.


RESULTS
A total of 140 patients with 168 episodes of GPC peritonitis (44% of all peritonitis) were identified over 7 years. Among these, 18 patients (13%) developed VS peritonitis, while 14 patients (10%) developed other streptococcal peritonitis. Patients with VS peritonitis had a high cure rate by antibiotic alone (94%), despite a high polymicrobial yield frequency (28%). We found that VS peritonitis carried a lower risk of Tenckhoff catheter removal and relapsing episodes than other GPC peritonitis (6% vs 11%), and a lower mortality than other streptococci peritonitis (0% vs 7%). However, after the index peritonitis episodes, VS, other streptococci, and other GPC group had a significantly increased peritonitis incidence compared with the period before the index peritonitis (all p < 0.01). Patients with VS peritonitis had a significantly higher incidence of refractory peritonitis compared with other streptococci or other GPC peritonitis in the long term (both p < 0.01).


CONCLUSIONS
VS poses a higher risk of subsequent refractory peritonitis after the index episode as compared with other streptococcal or GPC peritonitis. It might be prudent to monitor the technique of these patients with VS peritonitis closely to avoid further peritonitis episodes.
Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chia-Ter
CT
Chao
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
Szu-Ying
SY
Lee
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan.
Wei-Shun
WS
Yang
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Huei-Wen
HW
Chen
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Cheng-Chung
CC
Fang
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
Chung-Jen
CJ
Yen
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chih-Kang
CK
Chiang
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Kuan-Yu
KY
Hung
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Jenq-Wen
JW
Huang
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D034363:Viridans Streptococci / Q000302:isolation & purification*
End-stage renal disease; Streptococcus; peritoneal dialysis; peritonitis