Intra‐abdominal abscess with Prevotella species and Streptococcus anginosus co‐infection in a peritoneal dialysis patient
Abstract
Prevotella peritonitis is rare in patients receiving continuous ambulatory peritoneal dialysis (CAPD). We report the first case of the successful treatment of CAPD peritonitis together with intra-abdominal abscess formation due to Prevotella species and Streptococcus anginosus co-infection. An 80-yearold man who had end-stage kidney disease due to diabetic nephropathy received CAPD for 4 years. He presented with turbid peritoneal dialysate (PD) effluent and abdominal pain. He had neither fever nor tenckhoff catheter exit-site infection. His diabetic control was suboptimal (HbA1c 7.5%). The white cell count (WCC) in PD effluent was >10 000/cm (polymorphs predominating). Empirical treatment with intraperitoneal (IP) cefazolin 1 g and ceftazidime 1 g daily was started. Gram smear of PD effluent was negative but culture yielded S. anginosus (sensitive to penicillin (MIC: 0.032 μg/mL), levofloxacin, erythromycin and clindamycin). The PD effluent became clear after 4 days and repeated PD effluent WCC was 6/cm. Ceftazidime was stopped and he was maintained on IP cefazolin. The PD effluent became turbid again 10 days later (WCC >10 000/cm with 96% polymorphs). Gram smear of PD effluent showed Gram-positive cocci and culture yielded Prevotella nigrescens and Prevotella denticola, both were sensitive to metronidazole. Intravenous metronidazole 500 mg every 8 h and intravenous ceftriaxone 2 g daily were started. He had no signs and symptoms of periodontal disease. Computerized…
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