# A Case of Refractory Peritoneal Dialysis-Related Peritonitis Caused by Streptococcus gordonii

## TL;DR

An elderly woman with peritoneal dialysis developed persistent peritonitis caused by Streptococcus gordonii, which required catheter removal for resolution.

## Contribution

This case highlights S. gordonii's potential to cause refractory peritonitis via biofilm formation on dialysis catheters.

## Key findings

- Streptococcus gordonii was identified as the causative agent of refractory peritoneal dialysis-related peritonitis.
- Antibiotic treatment failed to resolve the infection, necessitating PD catheter removal for cure.
- Biofilm formation by S. gordonii is suggested as a mechanism for persistent infection.

## Abstract

An 82-year-old woman undergoing peritoneal dialysis (PD) presented to our hospital with cloudy PD effluent since four days. The leukocyte count in the effluent was elevated to 2900/μL, and the patient was diagnosed with PD-related peritonitis. Treatment with cefazolin and ceftazidime was initiated; however, the leukocyte count in the effluent did not improve. Culture of the effluent revealed the presence of Streptococcus gordonii. Treatment was switched to ampicillin monotherapy; however, when the leukocyte count in the effluent still did not normalize, the PD catheter was removed for management of refractory PD-related peritonitis, which was then cured. S. gordonii can form biofilms, suggesting that PD-related peritonitis may develop through the formation of biofilms on the catheter, leading to refractory peritonitis.