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Staphylococcus lugdunensis Peritoneal Dialysis-Related Peritonitis: A Matched Comparative Analysis
Winston W S Fung1, Ryan K-H Sze2, Cheuk-Chun Szeto1,3
1Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
Rationale & Objective:
Staphylococcus lugdunensis (S lugdunensis) is a coagulase-negative staphylococcus species that has been increasingly recognized to cause serious infections with virulence resembling Staphylococcus aureus (S aureus). No studies have evaluated the characteristics and outcomes of patients with S lugdunensis peritoneal dialysis-related peritonitis compared with those with S aureus peritonitis. We aim to evaluate the clinical course of peritonitis as caused by these organisms.
Study Design:
A retrospective matched comparative analysis involving a single tertiary center from July 2000 to July 2020.
Setting & Participants:
Forty-eight episodes of S aureus peritonitis were matched to 19 cases of S lugdunensis peritonitis.
Analytical Approach:
The cases were individually matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3). A comparative analysis was performed between the 2 organisms. The outcome includes responses at day 5 of peritonitis and the rate of complete response.
Results:
There is a higher predilection of diabetes in those with S aureus peritonitis than in those with S lugdunensis (64.6% vs 31.6%; P = 0.03). Patients with S aureus peritonitis also have a much higher total cell count at presentation (4,463.9 ± 5,479.5 vs 1,807.9 ± 3,322.7; P = 0.05); a higher prevalence of poor response at day 5 (50.0% vs 15.8%; P = 0.03); a lower rate of complete response (64.6% vs 94.7%; P = 0.01) and are more prone to relapse with the same organism (29.2% vs 0%, respectively; P = 0.01) as compared to those with S lugdunensis.
Limitations:
The result of this small retrospective study involving a single center may not be generalizable to other centers. There is also no data for comparative analysis on other coagulase-negative staphylococci such as Staphylococcus epidermidis, which belongs to the same family as S lugdunensis.
Conclusions:
Although S aureus peritonitis is more virulent with significant morbidity, S lugdunensis can cause similarly serious peritonitis. This largest case series of S lugdunensis peritonitis enabled better characterization of clinical features and outcomes of patients with S lugdunensis peritonitis.
Insights
Staphylococcus lugdunensis (S lugdunensis) peritonitis, though less common, shows better treatment response and lower relapse rates than Staphylococcus aureus (S aureus) peritonitis. This study highlights S lugdunensis as a significant cause of serious peritonitis.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Staphylococcus lugdunensis (S lugdunensis) is increasingly recognized for causing severe infections, with virulence comparable to Staphylococcus aureus (S aureus).
- Limited data exists on S lugdunensis peritonitis in patients undergoing peritoneal dialysis, especially in comparison to S aureus peritonitis.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of S lugdunensis peritonitis with S aureus peritonitis in patients on peritoneal dialysis.
- To evaluate treatment response and relapse rates for S lugdunensis versus S aureus peritonitis.
Main Methods:
- Retrospective matched comparative analysis of 19 S lugdunensis peritonitis cases and 48 S aureus peritonitis cases.
- Patients were matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3).
- Outcomes assessed included response at day 5 and complete response rate.
Main Results:
- S aureus peritonitis cases showed a higher predilection for diabetes (64.6% vs 31.6%) and higher initial cell counts.
- Patients with S aureus peritonitis had a higher prevalence of poor response at day 5 (50.0% vs 15.8%) and lower complete response rates (64.6% vs 94.7%).
- S aureus peritonitis was associated with a significantly higher relapse rate (29.2% vs 0%) compared to S lugdunensis peritonitis.
Conclusions:
- Despite S aureus peritonitis often being considered more virulent, S lugdunensis can cause similarly serious infections.
- S lugdunensis peritonitis demonstrated a superior treatment response and complete resolution rate compared to S aureus peritonitis in this cohort.
- This study provides valuable insights into the clinical features and outcomes of S lugdunensis peritonitis, contributing to the largest case series to date.
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