지속적 외래 복막투석 환자에서 카테터 제거 없이치유된 Comamonas Acidovorans 복막염 1예 (Comamonas Acidovorans Peritonitis in a CAPD Patient Managed withPreservation of the Catheter)

서지정보

· 발행기관 : 대한신장학회
· 수록지 정보 : Kidney Research and Clinical Practice / 21권 / 1호 / 175 ~ 177페이지
· 저자명 : 박철구, 강보리, 정은주, 박원도

초록

Comamonas acidovorans는 이전에는 Pseudomonas에 속해 있었으나, rRNA의 유사성에 기초해서 Xanthomonas로 분류된, 흙, 물 등에서 흔히 발견되는 그람음성 간균이다1). 뇌척수액, 침, 요, 인두, 상처 등에서 분리된 경우에2) 비병원성으로 생각되었으나, 중심정맥카테터를 삽입한 환자, 면역이 저하된 환자, AIDS 환자에서 폐렴을 동반한 경우, 정맥주입 약물 남용 환자에서 심내막염이 발생한 경우, 안감염 등에서는 균혈증의 원인 균으로 알려져 있다3-7). 복막투석 환자에서 본 균에 의한 복막염의 예가 외국에서 보고된 1예8)가 있으나, 국내에서는 보고된 바가 없기에 저자들은 문헌 고찰과 함께 보고하는 바이다.

영어초록

To date, only one case of peritonitis with exit site infection in peritoneal dialysis caused by this micro- organism has been reported. In spite of its apparently benign clinical course, which distinguished it from peritonitis caused by Pseudomonas, this peritonitis relapsed and Comamonas could not be eliminated from the peritoneal liquid, probably due to the persistence of the micro-organism in the exit site. Consequently, peritoneal catheter was removed. In this case, a 68-year-old man was admitted with fever, abdominal tenderness and cloudy peritoneal effluent and empirically treated with antibiotics(cefazolin, tobramycin), intraperitoneally(IP) for 7 days. The first culture was positive for Comamonas acidovorans, sensitive to ceftazidime, cefotetan, ceftriaxone, ciprofloxaxin and imipenem and the perotoneal effluent remained cloudy after 7 days. He was treated with ceftazidime IP, oral ciprofloxacin and nystatin for 26 days. 4 days after the antibiotics treatment, the patient was asymptomatic and the cell count of peritoneal effluent was 50 WBC/mm3 with negative culture. 25 days after the treatment, the patient remained asymptomatic and with 5 WBC/mm3 in peritoneal effluent. Consequently, We experienced a case of peritonitis due to Comamonas acidovorans in a patient on CAPD without exit site infection and managed with preservation of the catheter.

참고자료

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