Khurana Shriya, Chemmachel Christina, Saxena Ramesh
Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Case Rep Nephrol Dial. 2020 Nov 4;10(3):147-153. doi: 10.1159/000510147. eCollection 2020 Sep-Dec.
Most episodes of peritoneal dialysis (PD)-associated peritonitis are caused by skin-dwelling gram-positive bacteria and gram-negative bacteria colonizing gut and urinary tract. Occasionally, however, uncommon bacteria can cause peritonitis in PD patients. We describe a case of peritonitis, the first such case reported from the United States. A 68-year-old woman with end-stage kidney disease due to hypertension was initiated on PD 2 years prior to the present event. She presented with abdominal pain associated with nausea and vomiting. She was afebrile and hemodynamically stable. Abdomen was diffusely tender with guarding and rebound. No obvious root cause was apparent. Initial PD fluid white count was 502/mm with 87% neutrophils. Gram stain was negative. Culture grew gram-negative rods, which were later identified as , resistant to ampicillin and cefazolin but sensitive to gentamicin, ceftazidime, and cefepime. After empiric intraperitoneal vancomycin and gentamicin, she was continued on intraperitoneal gentamicin for a total period of 21 days. She responded to the treatment rapidly with complete recovery. PD fluid on day four showed 40 nucleated cells with 12% neutrophils. Patient remained on PD without consequences. is a gram-negative facultative anaerobic bacillus that can survive in water, including domestic water. Inadequate hand hygiene is a potential root cause of infection. Although rare, peritonitis can be observed in PD patients and is treatable. Clinicians should be aware of as a potential cause of PD peritonitis.
大多数腹膜透析（PD）相关腹膜炎病例是由皮肤寄居的革兰氏阳性菌以及定植于肠道和泌尿道的革兰氏阴性菌引起的。然而，偶尔也有不常见的细菌可导致PD患者发生腹膜炎。我们描述了一例腹膜炎病例，这是美国报道的首例此类病例。一名68岁因高血压导致终末期肾病的女性在本次事件发生前2年开始进行PD治疗。她出现腹痛并伴有恶心和呕吐。她无发热，血流动力学稳定。腹部弥漫性压痛，有肌卫和反跳痛。未发现明显的根本病因。初始PD液白细胞计数为502/mm，中性粒细胞占87%。革兰氏染色为阴性。培养出革兰氏阴性杆菌，后来鉴定为 ，对氨苄西林和头孢唑林耐药，但对庆大霉素、头孢他啶和头孢吡肟敏感。在经验性给予腹腔内万古霉素和庆大霉素后，她继续接受腹腔内庆大霉素治疗，总疗程为21天。她对治疗反应迅速，完全康复。第4天的PD液显示有40个有核细胞，中性粒细胞占12%。患者继续进行PD治疗，未出现不良后果。 是一种革兰氏阴性兼性厌氧杆菌，可在水中存活，包括生活用水。手部卫生不充分是感染的一个潜在根本原因。虽然罕见，但在PD患者中可观察到 腹膜炎，且可治疗。临床医生应意识到 是PD腹膜炎的一个潜在病因。
