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Abstract: PO1286

Streptococcus oralis Peritonitis in Peritoneal Dialysis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Winhtutoo, Swe Zin Mar, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Patel, Jayesh B., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Noureddine, Lama A., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Introduction

Peritonitis is the most common complication seen in peritoneal dialysis (PD). Although staphylococcal infections are most common, Streptococci are rare causes of ambulatory peritoneal dialysis (APD) peritonitis. We report a case of APD peritonitis due to Streptococcus oralis (also known as mitis) in a patient who habitually engages in nail-biting.

Case Description

A 57-year-old male with end-stage renal disease due to biopsy proven focal segmental glomerulosclerosis on PD since 2018 presented with 1 day of severe diffuse abdominal cramps. He has no known history of peritonitis. Vital signs were stable, and examination was notable for diffuse abdominal pain without rebound tenderness. PD catheter site was clean and dry. Abdominal CT scan did not reveal any acute intra-abdominal pathology. PD fluid was sent for cell count and culture. PD fluid was cloudy in appearance and amber in color. Due to concern for peritonitis, he was started on intraperitoneal vancomycin and tobramycin. Final fluid cell count was 20,900 WBCs/mm3 and final fluid culture was positive for Streptococcus mitis. He was successfully treated with 2 weeks of vancomycin, as he had an allergy to penicillin. He admitted that he is a habitual nail-biter. We educated him on the importance of hand hygiene and continuously adhering to a sterile dialysis technique.

Discussion

Streptococcus oralis is the most virulent of the streptococci viridians comprising normal human oral flora. It is primarily associated with dental caries but can have opportunistic pathogenicity in immunocompromised patients and can cause subacute infective endocarditis and septicemia if left untreated. Because the peritoneal cavity lacks robust innate immune response, it is a favored site for infection. Cefazolin is the antibiotic of choice for gram-positive cocci. Our patient denied breaking sterile technique but admitted that he is a nail-biter. He had no evidence of dental caries and didn’t seed through hematogenous spread. The only possible route of transmission was direct contamination from biting of his nails. We recommended the use of a bitter flavored nail biting deterrent nail polish at the time of discharge that could help him break his habit.