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.

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

“…Streptococci frequently originate from the mouth ( 175 ), although S. bovis typically comes from the colon ( 366 ). Peritonitis episodes caused by streptococci usually respond well to antibiotic treatment ( 175 , 367 ), but viridans streptococcal peritonitis are more likely to be refractory ( 368 ).…”

Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

“…However, from these total, 38 case series [ 15 – 52 ] were not included in the meta-analysis due to the lack of data. Methodological aspects of five RCT studies [ 53 – 57 ] had a risk of introducing bias, with inadequate blinding of participants, random sequence generation and incomplete outcome, and three RCTs was excluded from the quantitative analysis due to lack of data [ 53 , 56 , 58 ].…”

An Overview on Streptococcus bovis/Streptococcus equinus Complex Isolates: Identification to the Species/Subspecies Level and Antibiotic Resistance

“…In Hong Kong, China, among 48 SBSEC bacteremic isolates (mainly SGSP) collected over the period 1996–2001, an erythromycin resistance rate of 65% was found, mostly associated with erm (B) and erm (T), and a clindamycin resistance rate of 41% [24]. Another study from China, investigating clinical and microbiological features of 23 episodes of peritoneal dialysis peritonitis caused by S. bovis , reported resistance rates to clindamycin and erythromycin of 43.5% and 47.8%, respectively, [64]. A recent study from Taiwan, among 172 SBSEC collected between 2000 and 2012—including SGSG (126 isolates), SGSP (31 isolates), and S. infantarius (15 isolates)—54.7% of isolates were erythromycin-resistant, mostly showing the iMLS B phenotype (inducible resistance to macrolide, lincosamide, and streptogramin B antibiotics), thus with concomitant resistance also to clindamycin (54.1%) [43].…”