Group B streptococcus: an unusual cause of severe peritonitis in young children treated with continuous ambulatory peritoneal dialysis

Effective Treatment of Peritoneal Dialysis-Associated Peritonitis with Cefazolin and Ceftazidime in Children

Objective

To evaluate the use of the combination of cefazolin and ceftazidime for initial treatment of peritoneal dialysis (PD)-related peritonitis in pediatric patients.

Design

Retrospective nonrandomized study.

Setting

Pediatric dialysis units of the University Medical Center of Utrecht and Nijmegen, The Netherlands.

Patients

40 children (median age 5.4 years) who were treated with PD during the study period of 4.5 years.

Interventions

All 50 episodes of peritonitis that occurred during the study period were evaluated by review of medical records. Patients were given intraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L and cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were continued for 14 days.

Results

After identification of the causative microorganism, one of the antibiotics was discontinued in 34 cases, and the antibiotic schedule was adapted in 2 cases. All cases were initially cured within 3 days. In 5 cases (10%), there was a peritonitis with the same organism recurring within 2 weeks after completion of treatment. There were 4 cases of PD-related peritonitis caused by pseudomonas, all of which were cured.

Conclusions

The antibiotic combination of cefazolin and ceftazidime is effective for the initial therapy of PD-related peritonitis in children. The toxic complications of aminoglycosides are avoided with this combination.

Streptococcus agalactiae: a rare peritoneal infection in a continuous ambulatory peritoneal dialysis patient

Streptococcus agalactiae causes a rare and often fatal peritonitis in continuous ambulatory peritoneal dialysis (CAPD). A 52-year-old white female with Alport and chronic kidney disease was initiated on CAPD treatment. Nineteen months later she had a S. agalactiae peritonitis identified and received initially gentamicin-cephalothin, which was changed to ceftazidime, tobramycin, and vancomycin. Recovery started after peritoneal catheter removal. After 3 weeks, severe leucopenia occurred. Granulokine and steroids were given. Six weeks later, she felt well and an abdominal video laparoscopic procedure disclosed a diffuse peritoneal fibrosis, precluding CAPD resumption. She is now doing well on hemodialysis (HD).

Continuous ambulatory peritoneal dialysis-related peritonitis associated with Lancefield group G beta-hemolytic streptococcus: report of two cases requiring Tenckhoff catheter removal

We describe the first two cases of continuous ambulatory peritoneal dialysis-related peritonitis associated with Lancefield group G beta-hemolytic streptococci in the literature. Both patients presented with abdominal pain and turbid dialysis effluent with or without fever. Both had concomitant gastrointestinal tract disturbance. Both did not respond to intraperitoneal cefazolin and tobramycin and required removal of the Tenckhoff catheters.

Primary peritonitis due to group A streptococcus

Primary peritonitis is a rare condition occurring, by definition, in patients without underlying causes, such as perforated viscus, pre-existing ascites, or nephrosis. We report a case of primary peritonitis and shock due to group A beta-hemolytic streptococcus, a rare etiology. A review of the world's literature shows a predilection for women to have this condition. The entry site is obscure in most cases. Asymptomatic genital tract colonization may be a portal of entry in some women. Shock or toxic shock syndrome often accompany the abdominal findings. Laparotomy to exclude a perforated viscus may be unavoidable. Despite the significant morbidity, expeditious and appropriate antibiotic therapy is curative.

Fatal peritonitis due to group B beta-hemolytic streptococcus in a patient receiving chronic ambulatory peritoneal dialysis

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rarely caused by group B beta-hemolytic streptococcus species. We describe a 52-year-old man with chronic glomerulonephritis who developed a fatal peritonitis due to streptococcus group B in the absence of predisposing factors such as diabetes mellitus, malignancy, human immunodeficiency virus (HIV) infection, or liver disease. This report suggests that although beta-hemolytic streptococcus is a rare cause of peritonitis, the severity of the infection may be overwhelming and may rapidly lead to serious consequences and death.