RESUMO
Viridans-group streptococci, including the Streptococcus mitis/oralis subgroup, can cause peritoneal dialysis (PD)-related peritonitis. The link between dental pathology and PD-related peritonitis remains to be fully elucidated. We report a case of an 83-year-old man undergoing nocturnal intermittent PD due to kidney failure from diabetic nephropathy who developed S. mitis peritonitis and septicemia traced back to a periodontal abscess. Despite having no prior history of peritonitis and maintaining good nutritional status, the patient presented with generalized abdominal pain and a low-grade fever. The initial treatment included intraperitoneal antibiotics. Root cause analysis identified multiple periodontitis and dental abscesses as the primary source of infection, confirmed by DNA sequencing of cultures from the abscesses and blood, which matched S. mitis. This case highlights the critical role of oral flora in causing invasive diseases in immunocompromised individuals, including PD patients, and illustrates how dental infections can lead to PD-related peritonitis through hematogenous spread. Our case also stresses the importance of meticulous dental care and regular dental examinations to prevent such infections in PD patients.
RESUMO
Introduction: We sought to evaluate the associations of poor oral health hygiene with clinical outcomes in patients receiving peritoneal dialysis (PD). Methods: As part of the multinational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 participating PD centers throughout Thailand were enrolled from May 2016 to December 2019. The data were obtained from questionnaires that formed part of the PDOPPS. Oral health-related quality of life (HRQoL) used in this study was the short form of the oral health impact profile (oral health impact profile [OHIP]-14, including 7 facets and 14 items). Patient outcomes were assessed by Kaplan-Meier analysis. Cox proportional hazards model regression was used to estimate associations between oral HRQoL and clinical outcomes. Results: Of 5090 PD participants, 675 were randomly selected, provided informed consent, and completely responded to the OHIP-14 questionnaire. The median follow-up time of the study was 3.5 (interquartile range = 2.7-5.1 months) years. Poor oral health was associated with lower educational levels, diabetes, older age, marriage, and worse nutritional indicators (including lower time-averaged serum albumin and phosphate concentrations). After adjusting for age, sex, comorbidities, serum albumin, shared frailty by study sites, and PD vintage, poor oral health was associated with increased risks of peritonitis (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI]: 1.06-2.00) and all-cause mortality (adjusted HR = 1.55, 95% CI: 1.04-2.32) but not hemodialysis (HD) transfer (adjusted HR = 1.89, 95% CI: 0.87-4.10) compared to participants with good oral health. Conclusion: Poor oral health status was present in one-fourth of PD patients and was independently associated with a higher risk of peritonitis and death.
RESUMO
INTRODUCTION: We sought to evaluate the predictors and outcomes of mold peritonitis in patients with peritoneal dialysis (PD). METHODS: This cohort study included PD patients from the MycoPDICS database who had fungal peritonitis between July 2015-June 2020. Patient outcomes were analyzed by Kaplan Meier curves and the Log-rank test. Multivariable Cox proportional hazards model regression was used to estimating associations between fungal types and patients' outcomes. RESULTS: The study included 304 fungal peritonitis episodes (yeasts n = 129, hyaline molds n = 122, non-hyaline molds n = 44, and mixed fungi n = 9) in 303 patients. Fungal infections were common during the wet season (p <0.001). Mold peritonitis was significantly more frequent in patients with higher hemoglobin levels, presentations with catheter problems, and positive galactomannan (a fungal cell wall component) tests. Patient survival rates were lowest for non-hyaline mold peritonitis. A higher hazard of death was significantly associated with leaving the catheter in-situ (adjusted hazard ratio [HR] = 6.15, 95%confidence interval [CI]: 2.86-13.23) or delaying catheter removal after the diagnosis of fungal peritonitis (HR = 1.56, 95%CI: 1.00-2.44), as well as not receiving antifungal treatment (HR = 2.23, 95%CI: 1.25-4.01) or receiving it for less than 2 weeks (HR = 2.13, 95%CI: 1.33-3.43). Each additional day of antifungal therapy beyond the minimum 14-day duration was associated with a 2% lower risk of death (HR = 0.98, 95%CI: 0.95-0.999). CONCLUSION: Non-hyaline-mold peritonitis had worse survival. Longer duration and higher daily dosage of antifungal treatment were associated with better survival. Deviations from the 2016 ISPD Peritonitis Guideline recommendations concerning treatment duration and catheter removal timing were independently associated with higher mortality.