Group B Streptococcus peritonitis in patients on continuous ambulatory peritoneal dialysis: review article

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Introduction Group B Streptococcus (GBS), is a Gram-positive, beta-haemolytic bacterium that was first isolated by Lancefield in cows with bovine mastitis, and was later identified, in 1938, as a cause of fatal peripartum infections. Along with other beta-haemolytic streptococci, Streptococcus agalactia is associated with life-threatening infections in the adult population, such as blood stream infections, necrotising fasciitis and toxic shock syndrome. 1 While other Streptococcus species are associated with 10–15% of continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis, only scarce data about GBS peritonitis exist in the literature. Materials and Methods We reviewed the literature for culture-proven GBS CAPD-associated peritonitis. Databases searched included PubMed, Google Scholar and Scopus. Articles involved in the review originated from multiple geographical locations, including the USA, Europe and Brazil. Results and Discussion We found publications of culture-proven GBS peritonitis in the form of case reports describing eight cases (Table 1). 2–8 Five cases were reported between 1991 and 1995, including pediatric and adult patients. The course was complicated by septic shock in three of them. While one case was complicated by pleuroperitoneal fistula, two cases were complicated by bacteraemia. One patient did not survive the infection. Presentation was similar to other forms of peritonitis and included fever and abdominal pain. The cases were reported from USA, Brazil, France and the Netherlands. Another case, whose clinical course was favourable, was reported in 1999 from Italy in a 23-year-old woman who was also found to have vaginal colonisation with GBS. The presentation was preceded 12 h before by sexual intercourse, suggesting a possible source of the infection. Another case was reported in 2004 from Greece in a 27-year-old man whose sexual partner was found to have a vaginal isolate identical to the one isolated from the patient’s peritoneal fluid. This patient also had an uneventful course and recovered with antimicrobial therapy. The last case was reported in 2010 from Brazil in a 52-year-old woman who had Alport syndrome as the underlying aetiology of renal failure. Antimicrobial treatment was complicated by aplastic anaemia, which improved after administration of corticosteroids and granulocyte-stimulating factor. Renal replacement therapy was switched from peritoneal to haemodialysis because of underlying peritoneal fibrosis. She recovered with no long-term sequelae. Overall, most common antibiotics used were cephalothin and vancomycin. Conclusion In the presence of limited data, no wide-scale conclusions can be made on CADP-associated GBS peritonitis. More research is needed to identify the epidemiology, complications and mortality rate of CADP-associated GBS peritonitis.

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