CHARACTERISTICS OF STREPTOCOCCAL PERITONI TIS IN DPCA COMPARED TO PERITONITIS SECONDARY TO STAPHYLOCOCCUS-EPIDERMIDIS

Streptococcal peritonitis in CAPD is a puzzle that is becoming more fr equent and is still insufficiently understood probably because of its low incidence. To be able to asses the characteristics of this entity and their potential risk factors, we have performed a retrospective st udy including all the cases of streptococcal peritonitis described in our unit during a period of 16 years and we have compared part of them to a group of 45 peritonitis secondary to Staph. epidermidis that app eared in a similar period. In 16 years of our PD program there have be en 58 cases (12% of all the peritonitis episodes), 32 of them secondar y to Strep. viridans, 19 to E. faecalis and the rest to others alone o r associations among them. The age of the patients was 55.6 +/- 12.8 y ears; 65.5% were female, compared to 53.8% female patients in peritoni tis episodes secondary to other bacteria in our unit (p < 0.1). Time o n CAPD in these patients was 21.5 +/- 23.2 months. Their peritonitis r ate was 1.94 episodes per patient-year (significantly higher than our global peritonitis rate, p < 0.05). As a predisposing illness, hepatop athy was present in 7 cases (12%) and diverticulosis in 6 (8.6%). The episode was preceded by acute urinary, upper respiratory tract, cutane ous or digestive tract infections in 11 cases. Regarding treatment, be st results were obtained with 1st and 2nd generation cephalosporins wi th or without aminoglycosides. A high rate of in vivo resistance to va ncomycin was described. Response to ampicillin was excelent. Seventy t hree percent of patients had no change in their ultrafiltration rate a fter the episode. Streptococcus viridans peritonitis occurs in older p atients (p < 0.05) and is more related to the procedure than is perito nitis secondary to E. faecalis. Hepatopathy (p < 0.05), old age (p < 0 .1) and preceding acute digestive, respiratory, urinary or gynaecologi cal infections (p < 0.05) are risk factors for streptococcal peritonit is compared to those secondary to Staph. epidermidis. Its clinical exp ression is more aggressive. We conclude that streptoccocal peritonitis is more frequent in women and older patients, those with hepatotopath y or with a higher than average peritonitis rate, and is frequently pr eceded by acute infections that could be involved in their pathogenesi s though haematogenous spread or by bacteria from these foci being int roduced during handling of the CAPD equipment.