Staphylococcus lugdunensis Peritoneal Dialysis-Related Peritonitis: A Matched Comparative Analysis

Abstract

Staphylococcus lugdunensis (S lugdunensis) is a coagulase-negative staphylococcus species that has been increasingly recognized to cause serious infections with virulence resembling Staphylococcus aureus (S aureus). No studies have evaluated the characteristics and outcomes of patients with S lugdunensis peritoneal dialysis-related peritonitis compared with those with S aureus peritonitis. We aim to evaluate the clinical course of peritonitis as caused by these organisms. A retrospective matched comparative analysis involving a single tertiary center from July 2000 to July2020. Forty-eight episodes of S aureus peritonitis were matched to 19 cases of S lugdunensis peritonitis. The cases were individually matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3). A comparative analysis was performed between the 2 organisms. The outcome includes responses at day 5 of peritonitis and the rate of complete response. There is a higher predilection of diabetes in those with S aureus peritonitis than in those with S lugdunensis (64.6% vs 31.6%; P=0.03). Patients with S aureus peritonitis also have a much higher total cell count at presentation (4,463.9±5,479.5 vs 1,807.9±3,322.7; P=0.05); a higher prevalence of poor response at day 5 (50.0% vs 15.8%; P=0.03); a lower rate of complete response (64.6% vs 94.7%; P=0.01) and are more prone to relapse with the same organism (29.2% vs 0%, respectively; P=0.01) as compared to those with S lugdunensis. The result of this small retrospective study involving a single center may not be generalizable to other centers. There is also no data for comparative analysis on other coagulase-negative staphylococci such as Staphylococcus epidermidis, which belongs to the same family as S lugdunensis. Although S aureus peritonitis is more virulent with significant morbidity, S lugdunensis can cause similarly serious peritonitis. This largest case series of S lugdunensis peritonitis enabled better characterization of clinical features and outcomes of patients with S lugdunensis peritonitis.