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논문분류	춘계학술대회 초록집
제목	Endogenous bacterial endopthalmitis from cuffed tunneled hemodialysis catheter infection.
저자	Youngrok Ham* 1, 1, Wonjung Choi, Hae Ri Kim1, Hong Jae Jeon, Dae Eun Choi, Ki Ryang Na, Kang Wook Lee
출판정보	2016; 2016(1):
키워드	catheter, endopthalmitis
초록	Background: Endogenous bacterial endopthalmitis (EBE) is very rare ocular disease. Patients with immunosuppressive disease such as diabetes mellitus, chronic kidney disease and human immunodeficiency virus infection and intravascular drugs user are vulnerable. Most common cause of EBE is liver abscess by Klebsiella pneumonia and Escherichia coli. On the other hand, catheter related infection which is a common infection in a third medical center is not the common cause of EBE. Here, we report the ipsilateral EBE from tunnel infection of cuffed tunneled hemodialysis catheter. Methods: Forty-one year-old man was admitted to our emergency room with decreased vision and fever. He was diagnosed with hypertensive chronic kidney disease 7 years ago and regular hemodialysis was started via tunneled cuffed hemodialysis catheter (TCC) 2 years ago. His TCC was changed twice because of dysfunction and last TCC were placed 9 months ago. Three days before admission, he complained of TCC insertion site pain and swelling and had medication composed of antibiotics and antipyretics. On the day of admission, the skin around tunnel of TCC showed redness, heating sense, tenderness and swelling on physical examination. Left eye showed conjunctival injection, iris pigment on anterior surface of lens and diffuse round exudate membrane. Right eye was not involved. To find out the source of endopthalmitis, abdominal-pelvic computed tomography was taken. However, only mild fatty liver and kidneys with atrophied cortex were shown. Moreover, transesophageal echocardiography did not show the evidence of endocarditis. We removed TDCs immediately and start vancomycin and moxifloxacin to cover MRSA and other gram negative bacteria. In addition, ophthalmologist recommended him emergent vitrectomy, but he refused. Alternatively, he wanted to get intravitreal and systemic antibiotics. Intravitreal vancomycin and ceftazidime for three times every other day and systemic vancomycin and moxifloxacin were injected for empirical antibiotics before MRSA was cultured in TDC tip culture, not blood culture. Thereafter we used systemic vancomycin only. Results: C-reactive protein was decreasing during systemic antibiotics treatment from 30.5 mg/dL to 2.8 mg/dL. To improve prognosis of involved eye, we repeatedly recommended him get vitrectomy. On the 11th day of hospitalization, pars plana vitrectomy was done. Finally, he discharged on the 26thday of hospitalization with oral amoxicillin and moxifloxacin. Conclusion: EBE is a usually hematogenous infection from other origin such as liver abscess, urinary tract infection and endocarditis, etc. Although the outcomes of EBE are generally poor, early diagnosis and prompt administration of antibiotics can improve visual prognosis and clinical outcomes. Clinicians should therefore be aware of early symptoms and signs of EBE when catheter infection occurs.
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