Berrocal Carlos, Quintero-Romero J M, Mejia Luz, Zapata-Aristizábal A, Nati-Castillo H A, Gaibor-Pazmiño Alice, Izquierdo-Condoy Juan S
Departamento de Medicina Interna, Universidad del Valle, Cali, Colombia.
Facultad de Medicina, Corporación Universitaria Empresarial Alexander von Humboldt, Armenia, Colombia.
Front Med (Lausanne). 2025 Sep 2;12:1652738. doi: 10.3389/fmed.2025.1652738. eCollection 2025.
Peritonitis is a major complication of peritoneal dialysis, most often caused by gram-positive cocci. (Group B Streptococcus) is an exceptionally rare pathogen in this context.
We describe a 64-year-old man with end-stage renal disease on long-term PD who developed refractory peritonitis due to . Peritoneal fluid analysis revealed 525 leukocytes/μL (74% polymorphonuclear cells) and Gram-positive cocci. Cultures confirmed , fully susceptible to all tested antibiotics. Despite intraperitoneal vancomycin, the patient showed no clinical improvement. Because of limited intraperitoneal antibiotic availability, intravenous ampicillin-sulbactam (1.5 g every 12 h) was initiated, combined with prophylactic oral fluconazole. Clinical resolution was achieved after 10 days, followed by four days of oral therapy. The peritoneal catheter was subsequently removed, and the patient transitioned to intermittent hemodialysis.
This case represents the first documented success of intravenous ampicillin-sulbactam for -associated peritonitis in PD. It expands the therapeutic options for this rare and challenging infection and highlights the importance of culture-guided management and adaptive treatment strategies, particularly in resource-limited settings where conventional intraperitoneal therapies may be unavailable.
腹膜炎是腹膜透析的主要并发症，最常见的病因是革兰氏阳性球菌。在这种情况下，B组链球菌是一种极为罕见的病原体。
我们描述了一名64岁患有终末期肾病且长期进行腹膜透析的男性患者，他因B组链球菌感染而发展为难治性腹膜炎。腹膜液分析显示白细胞计数为525/μL（74%为多形核细胞），并发现革兰氏阳性球菌。培养结果证实为B组链球菌，对所有测试抗生素均敏感。尽管使用了腹腔内万古霉素，但患者并无临床改善。由于腹腔内可用抗生素有限，开始静脉注射氨苄西林-舒巴坦（每12小时1.5克），并联合预防性口服氟康唑。10天后临床症状得到缓解，随后进行了4天的口服治疗。随后拔除了腹膜导管，患者转而接受间歇性血液透析。
该病例是首次记录静脉注射氨苄西林-舒巴坦成功治疗腹膜透析中B组链球菌相关腹膜炎的案例。它扩展了针对这种罕见且具有挑战性感染的治疗选择，并强调了培养指导管理和适应性治疗策略的重要性，特别是在资源有限的环境中，传统的腹腔内治疗可能无法使用。
