PDF(Pubmed)
Abstract：
BACKGROUND Peritoneal dialysis (PD) serves as a critical renal replacement therapy for individuals with end-stage renal disease (ESRD), leveraging the peritoneum for fluid and substance exchange. Despite its effectiveness, PD is marred by complications such as peritonitis, which significantly impacts patient outcomes. The novelty of our report lies in the presentation of a rare case of PD-associated peritonitis caused by 2 unusual pathogens, emphasizing the importance of rigorous infection control measures. CASE REPORT We report on an 80-year-old African-American female patient with ESRD undergoing PD, who was admitted twice within 8 months for non-recurring episodes of peritonitis. These episodes were attributed to the rare pathogens Achromobacter denitrificans/xylosoxidans and Carbapenem-resistant Acinetobacter baumannii. Despite presenting with similar symptoms during each episode, such as abdominal pain and turbid dialysis effluent, the presence of these uncommon bacteria highlights the intricate challenges in managing infections associated with PD. The treatment strategy encompassed targeted antibiotic therapy, determined through susceptibility testing. Notably, the decision to remove the PD catheter followed extensive patient education, ensuring the patient comprehended the rationale behind this approach. This crucial step, along with the subsequent shift to hemodialysis, was pivotal in resolving the infection, illustrating the importance of patient involvement in the management of complex PD-related infections. CONCLUSIONS This case underscores the complexities of managing PD-associated peritonitis, particularly with uncommon and resistant bacteria. It emphasizes the importance of rigorous infection control measures, the need to consider atypical pathogens, and the critical role of patient involvement in treatment decisions. Our insights advocate for a more informed approach to handling such infections, aiming to reduce morbidity and improve patient outcomes. The examination of the literature on recurrent peritonitis and treatment strategies provides key perspectives for navigating these challenging cases effectively.
摘要：
背景技术腹膜透析(PD)作为终末期肾病(ESRD)患者的关键肾脏替代疗法。利用腹膜进行液体和物质交换。尽管有效,PD因腹膜炎等并发症而受损，这显著影响了患者的预后。我们的报告的新颖性在于介绍了由2种异常病原体引起的罕见PD相关性腹膜炎病例，强调严格的感染控制措施的重要性。病例报告我们报告了一名80岁的非洲裔美国女性ESRD患者，他在8个月内两次因非复发性腹膜炎发作入院。这些事件归因于罕见病原体反硝化嗜酸性杆菌/木氧杆菌和耐碳青霉烯类鲍曼不动杆菌。尽管每次发作都有类似的症状，如腹痛和浑浊的透析流出物，这些罕见细菌的存在凸显了治疗与PD相关感染的复杂挑战.治疗策略包括靶向抗生素治疗，通过敏感性测试确定。值得注意的是,移除PD导管的决定遵循广泛的患者教育，确保患者理解这种方法背后的基本原理。这关键的一步,随着随后转向血液透析，是解决感染的关键，说明患者参与复杂PD相关感染管理的重要性。结论该病例强调了治疗PD相关腹膜炎的复杂性，特别是不常见和耐药的细菌。它强调了严格的感染控制措施的重要性，需要考虑非典型病原体，以及患者参与治疗决策的关键作用。我们的见解主张采取更明智的方法来处理此类感染，旨在降低发病率并改善患者预后。对复发性腹膜炎和治疗策略的文献检查为有效地导航这些具有挑战性的病例提供了关键观点。
