Peritonitis due to Streptococcus viridans in patients receiving continuous ambulatory peritoneal dialysis.

Kiddy, K; Brown, Phillip P.; Michael, J; Adu, D.

doi:10.1136/bmj.290.6473.969-a

Cited by 30 publications

(11 citation statements)

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“…In addition, the use of dental floss is generally considered a good oral hygiene habit; however, it can promote gingival bleeding and lead to bacteremia depending on how it is used . Although it is well‐known that dental procedures can cause PD‐related peritonitis through the bloodstream , the use of dental floss can also cause PD‐related peritonitis through the local bloodstream. Based on this hypothesis, it is possible to explain why there was no significant association between the incidence of PD‐related peritonitis and the use of dental floss.…”

Section: Discussionmentioning

confidence: 99%

Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis

et al. 2018

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Some peritoneal dialysis (PD)‐related peritonitis cases are thought to be caused by the pathogens in the oral cavity; however, the relationship between peritonitis and oral hygiene habits is unclear. In this study, we retrospectively examined the relationship between oral hygiene habits and peritonitis in patients who agreed to a questionnaire survey. Of the 75 patients, 37 patients developed PD‐related peritonitis during the observation period. Peritonitis‐free survival was significantly higher in patients who spent more time on oral hygiene daily and in patients who replaced their toothbrush more frequently (P < 0.05). According to multivariable analysis, increased daily oral hygiene duration and more frequent toothbrush replacement were associated with a significantly (P < 0.01) lower risk for peritonitis (hazard ratio [HR] 0.37 [95% CI, 0.18–0.77] and HR 0.35 [95% CI, 0.17–0.70], respectively). In conclusion, PD patients with superior oral hygiene habits showed a lower risk for PD‐related peritonitis.

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Section: Discussionmentioning

confidence: 99%

Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis

et al. 2018

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“…None of our patients had any dental procedure before the onset of S salivarius infection. Kiddy et al 25 reported 4 cases of VGS peritonitis in patients receiving continuous ambulatory peritoneal dialysis 2 to 7 days after dental surgery or the onset of a lesion in the mouth. Four patients underwent transthoracic echocardiogram during the workup of their illness.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

et al. 2007

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Bacterial infections are a serious complication of end-stage liver disease (ESLD) that occurs in 20% to 60% of patients. We retrospectively reviewed medical records of patients with ESLD who were identified by our microbiology laboratory as having Streptococcus salivarius bacteremia. Of 592 patients listed for transplantation between January 1998 and January 2006, 9 (1.5%) had 10 episodes of S salivarius bacteremia. Of 2 patients already receiving quinolone prophylaxis for spontaneous bacterial peritonitis (SBP), 1 later presented with a second episode. The male-to-female ratio was 1:1.2. Medians for age, Model for End-Stage Liver Disease score, and Child-Turcotte-Pugh score were 50 years, 17, and 10, respectively. Presenting symptoms and signs in 10 episodes of infection were ascites (in 8 episodes), elevated temperature (6), abdominal pain (5) Bacterial infections are a common and serious complication of end-stage liver disease (ESLD). Their prevalence has been reported to range from 20 to 60%. 1,2 They are associated with increased morbidity and overall in-hospital mortality.1,2 Proposed mechanisms for increased risk of infection are changes in humoral immunity with a decreased synthesis in the complement system, 3 a decrease in the phagocytosis capability of the hepatic reticuloendothelial system, 4 an alteration in the function of neutrophils, 5,6 and a reduction in opsonic activity of ascitic fluid. 7 In addition, rupture of natural barriers induced by invasive diagnostic or therapeutic procedures may be involved in the pathogenesis of infections.Commonly observed infections in cirrhotic patients are pneumonia, urinary tract infection, spontaneous bacterial peritonitis (SBP), and bacteremia. Most of these infections are community acquired. In 1 series, two-thirds of the episodes were caused by gram-negative bacteria, 21% by gram-positive bacteria, and 3% by anaerobic bacteria. 8 In a more recent series of 117 cases of bacteremia, about one-half of the infections were caused by gram-negative bacteria and about onehalf by gram-positive bacteria. 9 We have encountered cases of S salivarius bacteremia among patients listed for liver transplantation at our tertiary care academic medical institution. Herein, we present our experience with this infection in patients with ESLD who were managed at our institution. PATIENTS AND METHODSAfter we encountered 2 liver transplantation candidates with S salivarius bacteremia, we reviewed the electronic Abbreviations: ESLD, end-stage liver disease; SBP, spontaneous bacterial peritonitis; VGS, viridans group streptococci.

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“…The most frequent agents, viridans streptococci (Streptococcus mitis, Streptococcus sanguis, and Streptococcus salivarius) (90,131), mostly of oral origin, could contaminate the connecting site (2) or spread via a hematogenous route, e.g., after dental work (65). Enterococcal peritonitis corresponds in pathogenesis and severity to peritonitis caused by members of the Enterobacteriaceae (143).…”

Section: Streptococcimentioning

confidence: 99%

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

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Peritonitis due to Streptococcus viridans in patients receiving continuous ambulatory peritoneal dialysis.

Cited by 30 publications

References 5 publications

Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis

Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

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