The Warren Alpert Medical School of Brown University, Providence, RI.
The Warren Alpert Medical School of Brown University; Department of Kidney and Hypertension, Rhode Island Hospital, Providence, RI.
R I Med J (2013). 2024 Feb 1;107(2):16-19.
Peritonitis, a serious complication of peritoneal dialysis (PD), can be caused by opportunistic pathogens like Micrococcus species on rare occasions. We present a case of Micrococcus sp peritonitis in a 55-year-old female with end-stage kidney disease on continuous cycling peritoneal dialysis for one year who presented with cloudy effluent. Initial treatment against Micrococcus sp with vancomycin, gentamicin, and prophylactic oral nystatin was successful. However, one month later, the patient presented with abdominal pain and dialysate culture again grew Micrococcus sp. Treatment with vancomycin was unsuccessful in resolving culture positivity. The patient was transitioned to hemodialysis for non-medical reasons and then was later restarted on PD without further peritonitis episodes. Micrococcus sp peritonitis in PD poses treatment challenges due to limited guidelines. Intraperitoneal vancomycin is commonly used to target Micrococcus isolates although there is a high incidence of treatment failure. This case report highlights the need for continued reporting to enhance identification, prevention, and patient outcomes in Micrococcus sp peritonitis during PD.
腹膜炎是腹膜透析（PD）的一种严重并发症，在极少数情况下，机会性病原体如微球菌属也可能导致腹膜炎。我们报告了一例 55 岁女性的微球菌属腹膜炎病例，该女性患有终末期肾病，已接受持续循环 PD 治疗 1 年，出现混浊的流出液。最初使用万古霉素、庆大霉素和预防性口服制霉菌素治疗微球菌属取得了成功。然而，一个月后，患者出现腹痛，且透析液培养再次生长出微球菌属。万古霉素治疗未能成功清除培养阳性。由于非医疗原因，患者转为血液透析，随后因其他原因再次开始 PD 治疗，此后未再发生腹膜炎。PD 中的微球菌属腹膜炎由于指南有限，治疗具有挑战性。尽管治疗失败的发生率很高，但通常使用腹腔内万古霉素来针对微球菌属分离株。本病例报告强调了需要继续报告，以提高 PD 期间微球菌属腹膜炎的识别、预防和患者结局。
