Kilic Ilhan, Gungor Kultural, Kurultak Ilhan, Ustundag Sedat
Department of Nephrology, Kìrklareli State Hospital, Kìrklareli, Turkey.
Department of Infectious Diseases, Medical Faculty, Trakya University, Edirne, Turkey.
Saudi J Kidney Dis Transpl. 2018 Nov-Dec;29(6):1494-1497. doi: 10.4103/1319-2442.248298.
Serratia marcescens (SM) is an opportunistic Gram-negative bacterium. It can cause technique failure or severe sepsis despite being a rare agent causing peritonitis. We present a case of a 40-year-old woman with end-stage renal disease secondary to chronic glomerulo-nephritis on continuous ambulatory peritoneal dialysis (PD). She presented with severe abdominal pain and a cloudy peritoneal fluid. The fluid was cultured according to our unit protocol. The organism isolated was identified as SM; this was after the patient was treated for SM peritonitis one week earlier. The response to treatment with ceftazidime was poor despite being sensitive in vitro. The peritoneal catheter was removed due to rapid clinical deterioration. Piperacillin-tazobactam (PIP/TAZ) monotherapy was successfully administered subsequently. Eventually, she was transferred to hemodialysis (HD). SM is an uncommon cause of PD-related peritonitis. It may cause catheter loss and even death. In our case, the infection could be controlled only after catheter removal, and she was transferred to HD. Cephalosporins should rapidly be changed to PIP/TAZ when SM is isolated from the peritoneal fluid.
粘质沙雷氏菌（SM）是一种机会性革兰氏阴性菌。尽管它是引起腹膜炎的罕见病原体，但可导致技术失败或严重脓毒症。我们报告一例40岁女性患者，继发于慢性肾小球肾炎的终末期肾病，正在接受持续性非卧床腹膜透析（PD）。她出现严重腹痛和浑浊的腹膜透析液。根据我们科室的方案对透析液进行培养。分离出的病原体被鉴定为粘质沙雷氏菌；这是在患者一周前因粘质沙雷氏菌腹膜炎接受治疗之后。尽管体外药敏显示头孢他啶敏感，但治疗反应不佳。由于临床迅速恶化，拔除了腹膜透析导管。随后成功给予哌拉西林-他唑巴坦（PIP/TAZ）单药治疗。最终，她转至血液透析（HD）治疗。粘质沙雷氏菌是腹膜透析相关腹膜炎的罕见病因。它可能导致导管拔除，甚至死亡。在我们的病例中，仅在拔除导管后感染才得到控制，并且患者转至血液透析治疗。当从腹膜透析液中分离出粘质沙雷氏菌时，应迅速将头孢菌素更换为PIP/TAZ。
