Peritoneal Dialysis-Related Peritonitis Caused by Streptococcus oralis

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritonitis is a serious complication of peritoneal dialysis (PD).
• Common pathogens include Staphylococcus and Enterococcus species.
• Infections caused by oral streptococci are rare in PD patients.

Observation:

• A 77-year-old male PD patient presented with peritonitis.
• The causative agent was identified as Streptococcus oralis.
• Initial treatment with intraperitoneal antibiotics (cefazolin and ceftazidime) for one week was ineffective.

Findings:

• The peritonitis resolved only after a switch to two weeks of intravenous cefazolin and ceftazidime.
• The patient had no significant dental issues or recent dental procedures.
• This suggests an extra-oral source for the Streptococcus oralis infection.

Implications:

• Streptococcus oralis can cause refractory peritonitis in PD patients.
• An extra-oral infection route should be considered for rare pathogen peritonitis.
• Intravenous administration may be more effective than intraperitoneal for certain S. oralis infections in PD.