Hematogenous infection of peritoneovenous shunts after dental procedures

In two patients who had peritoneovenous shunts inserted for the treatment of intractable ascites, the shunt became infected following dental procedures that were carried out without antibiotic prophylaxis. The organisms grown were alpha-hemolytic streptococcus in one patient, and alpha-hemolytic streptococcus and Klebsiella pneumoniae in the other. Alpha hemolytic streptococcus is commonly found in the oral cavity and has also been found, related to dental manipulations, in hematogenous infections at other sites. In both patients the infections were successfully managed by antibiotic treatment with removal of the infected shunt. Physicians caring for patients with peritoneovenous shunts should be aware of this potential complication; antibiotics should always be given prophylactically at the time of dental procedures.