一例罕见的成人腹膜透析患者的甘露醇溶性Ralstonia腹膜炎。

Joseph Kim, Litty Thomas, Kavita Bhavan, Ramesh Saxena
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引用次数: 0

摘要

腹膜炎是腹膜透析(PD)的常见并发症,通常由皮肤上的革兰氏阳性细菌和革兰氏阴性细菌定植于肠道和泌尿道引起。偶尔,罕见的细菌可引起腹膜炎的PD患者。我们描述一个病例的Ralstonia甘露醇溶性腹膜炎在一个67岁的妇女谁已经在PD超过10年没有腹膜炎的先前发作。据我们所知,这是美国第一例报道的拉尔斯顿菌腹膜炎。她最初表现为腹部压痛,右侧腹痛,肾造口管排出物混浊。PD液和尿培养培养出对治疗有反应的大肠杆菌。然而,她的症状在完成抗生素治疗后再次出现,PD液中生长着Ralstonia物种。她再次对腹腔内抗生素有反应,但在完成第二疗程抗生素治疗后症状复发。PD液中的甘露醇溶Ralstonia对先前的抗生素治疗方案产生了耐药性。PD导管被取出,她开始进行血液透析。随后的治疗使她的症状得到缓解。拉氏菌属属革兰氏阴性菌,普遍存在于供水系统中,可形成生物膜。已知它们可引起感染,特别是在新生儿、免疫功能低下患者或重症监护患者中。在我们的病人中,先前的抗生素治疗大肠杆菌腹膜炎可能导致了拉尔斯顿菌腹膜炎的发展。PD导管拔除后的临床改善表明,PD导管上的种子可能是反复感染的罪魁祸首。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rare case of Ralstonia mannitolilytica peritonitis in an adult peritoneal dialysis patient.

Peritonitis is a common complication of peritoneal dialysis (PD) usually caused by skin-dwelling Gram-positive bacteria and Gram-negative bacteria colonizing the gut and urinary tract. Occasionally, uncommon bacteria can cause peritonitis in PD patients. We describe a case of Ralstonia mannitolilytica peritonitis in a 67-year-old woman who has been on PD for more than 10 years with no prior episodes of peritonitis. To our knowledge, this is the first reported case of Ralstonia peritonitis in the United States. She initially presented with abdominal tenderness, right flank pain, and cloudy output from her nephrostomy tube. PD fluid and urine cultures grew E. coli which responded to treatment. However, her symptoms recurred after completion of antibiotic therapy with PD fluid growing Ralstonia species. She again responded to intraperitoneal antibiotics but had recurrence of symptoms after the completion of her second course of antibiotics. PD fluid grew Ralstonia mannitolilytica resistant to the prior antibiotic regimen. The PD catheter was removed, and she was transitioned to hemodialysis. Subsequent treatment led to the resolution of her symptoms. Ralstonia species are Gram-negative bacteria that are prevalent in water supplies and can form biofilms. They have been known to cause infection particularly in neonates, immunocompromised patients, or patients in intensive care. In our patient, prior antibiotic treatment for E. coli peritonitis is likely to have contributed to the development of Ralstonia peritonitis. Clinical improvement after removal of the PD catheter revealed that seeding from the PD catheter was the likely culprit for the recurrent infections.

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