青霉菌导致腹膜透析相关性腹膜炎1例并文献复习
Penicillium caused peritoneal dialysis-associated peritonitis:a case report and literature review
王毓琦 1胡明亮 1王丽 1梁彩星 1王晓双1
作者信息
- 1. 广东医科大学深圳龙华临床医学院(深圳市龙华区人民医院)肾内科,广东深圳 518109
- 折叠
摘要
腹膜透析相关性腹膜炎是腹膜透析治疗的严重并发症,可导致多种不良临床结局.因此,预防及治疗腹膜透析相关性腹膜炎是改善患者预后的重要环节.临床上大多数腹膜透析相关性腹膜炎是由革兰氏阳性球菌引起的,青霉菌属较为罕见.本文报道1例45岁女性腹膜透析相关性腹膜炎患者,既往行电子结肠镜检查提示结直肠炎.入院后先后使用左氧氟沙星、亚胺培南西司他丁、氟康唑等抗感染治疗,后续腹膜透析管微生物培养结果提示青霉菌感染,予拔除腹膜透析管并使用伏立康唑抗真菌治疗后腹膜炎治愈.本例患者在诊治过程中发现其临床表现及常规实验室检查无特异性,对于治疗效果不佳或病原体培养阴性的腹膜炎患者,需警惕青霉菌感染的可能.在及时、规范治疗腹膜炎的同时应注意识别并处理腹膜透析相关性腹膜炎的易感因素.
Abstract
Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis treatment,which can lead to a variety of adverse clinical outcomes.Therefore,the prevention and treatment of peritoneal dialysis-associated peritonitis is an important step to improve the prognosis of patients.Most peritoneal dialysis-associated peritonitis is caused by gram-positive bacteria,of which penicillium is rare.In this paper,a 45-year-old female patient with peritoneal dialysis-associated peritonitis was reported,who had previously received electronic colonoscopy indicating coliti.The patient treated with anti-infective therapy such as levofloxacin,imipenemenciastatin,fluconazole,etc.Subsequent peritoneal dialysis tube microbial culture results indicated penicillium infection,and peritonitis was cured after the peritoneal dialysis tube was extracted and replaced with voriconazole antifungal therapy.The diagnosis and treatment of this patient indicated that the clinical manifestations of the disease and routine laboratory examination were non-specific,and the possibility of penicillium infection should be vigilant for patients with poor treatment effect or negative culture of peritonitis.While timely and standardized treatment of peritonitis,attention should be paid to identifying and treating the predisposing factors of peritonitis associated with peritoneal dialysis.
关键词
腹膜透析/腹膜炎/真菌感染/青霉菌属/肾脏疾病Key words
Peritoneal dialysis/Peritonitis/Fungal infection/Penicillium genus/Kidney disease引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据