{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T06:10:03Z","timestamp":1756793403670,"version":"3.44.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Peritonitis is a major complication of peritoneal dialysis, most often caused by gram-positive cocci. <jats:italic>Streptococcus agalactiae<\/jats:italic> (Group B Streptococcus) is an exceptionally rare pathogen in this context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We describe a 64-year-old man with end-stage renal disease on long-term PD who developed refractory peritonitis due to <jats:italic>S. agalactiae<\/jats:italic>. Peritoneal fluid analysis revealed 525 leukocytes\/\u03bcL (74% polymorphonuclear cells) and Gram-positive cocci. Cultures confirmed <jats:italic>S. agalactiae<\/jats:italic>, fully susceptible to all tested antibiotics. Despite intraperitoneal vancomycin, the patient showed no clinical improvement. Because of limited intraperitoneal antibiotic availability, intravenous ampicillin\u2013sulbactam (1.5\u202fg every 12\u202fh) was initiated, combined with prophylactic oral fluconazole. Clinical resolution was achieved after 10\u202fdays, followed by four days of oral therapy. The peritoneal catheter was subsequently removed, and the patient transitioned to intermittent hemodialysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case represents the first documented success of intravenous ampicillin\u2013sulbactam for <jats:italic>S. agalactiae<\/jats:italic>\u2013associated 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1652738","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T05:32:27Z","timestamp":1756791147000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["First successful use of ampicillin-sulbactam for rare Streptococcus agalactiae-associated peritonitis in peritoneal dialysis: a case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Carlos","family":"Berrocal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. M.","family":"Quintero-Romero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz","family":"Mejia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Zapata-Aristiz\u00e1bal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. A.","family":"Nati-Castillo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Gaibor-Pazmi\u00f1o","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan S.","family":"Izquierdo-Condoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s12882-024-03594-y","article-title":"Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center","volume":"25","author":"Nardelli","year":"2024","journal-title":"BMC Nephrol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit Dial Int J Int Soc Perit Dial"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.2215\/CJN.14631218","article-title":"Peritoneal Dialysis-associated peritonitis","volume":"14","author":"Szeto","year":"2019","journal-title":"Clin J Am Soc Nephrol CJASN."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.2215\/CJN.09280913","article-title":"Peritoneal Dialysis\u2013related peritonitis due to coagulase-negative Staphylococcus: a review of 115 cases in a Brazilian Center","volume":"9","author":"Camargo","year":"2014","journal-title":"Clin J Am Soc Nephrol CJASN"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/ciy381","article-title":"A guide to utilization of the microbiology Laboratory for Diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology","volume":"67","author":"Miller","year":"2018","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3545","DOI":"10.1093\/ndt\/gfl407","article-title":"Streptococcal PD peritonitis--a 10-year review of one Centre\u2019s experience","volume":"21","author":"Shukla","year":"2006","journal-title":"Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - 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