背景:腹膜炎是腹膜透析(PD)患者的重要并发症和发病原因。棒状杆菌属物种,通常被认为是皮肤和粘膜污染物,是PD相关性腹膜炎的一种罕见病因,并且仅在过去10年才在已发表的PD腹膜炎诊断和治疗指南中得到认可。
方法:我们介绍了两名因淀粉棒状杆菌引起的难以治疗的PD腹膜炎发作的儿童。发作与发烧有关,腹痛和浑浊的透析液,高透析液多形核白细胞计数,血清C反应蛋白和降钙素原浓度升高。5次腹膜炎发作中有4次症状持续超过5天,尽管细菌分离株对指南推荐的抗生素具有体外敏感性,但腹膜炎复发。尽管进行了4周的腹膜内糖肽治疗,并且临床腹膜炎消退提示有效的生物膜形成,但从PD导管尖端培养了淀粉样杆菌。我们的系统文献检索确定了三个以前的(成人)淀粉样腹膜炎的病例描述,都是由同一个有机体重复发作的。作为PD腹膜炎的原因的淀粉样杆菌的发病率尚未确定,但由于物种分化的挑战,可能被低估了。
结论:C.淀粉样蛋白是难治性和/或复发性PD腹膜炎的罕见病因。非白喉棒状杆菌分离株的物种分化至关重要,和长期的抗生素治疗,优选使用糖肽抗生素,推荐,在反复腹膜炎的情况下,PD导管改变或移除的阈值较低。
Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade.
We present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation.
C. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.