대한신장학회

논문분류	춘계학술대회 초록집
제목	A case of peritoneal dialysis-associated peritonitis caused by Agromyces mediolanus
저자	In O Sun* 1, A Young Cho1, Hyun Ju Yoon1, Youngsuk Kim2, Jae Hyeon Lee3, Kwang Young Lee1
출판정보	2016; 2016(1):
키워드	Peritoneal dialysis, Peritonitis, Procalcitonin
초록	Background: Agromyces mediolanus (A. mediolanus) is a gram-positive organism found in soil and is an unusual pathogen in human infection. Only one case of human infection by A. mediolanus was reported in the world and no cases of peritoneal dialysis (PD)-associated peritonitis by A. mediolanus have never been reported yet. Methods: We report the first case of PD-associated peritonitis due to A. mediolanus, which was identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry. The patient recovered following catheter removal and intravenous antibiotic treatment. Results: A 59-year-old Korean man who had been treated with CAPD for 2 years was admitted to our hospital because of turbid peritoneal effluent accompanied by constant diffuse abdominal pain that began 2-weeks prior to his admission. On admission, his blood pressure was 160/80 mm Hg, heart rate was 78 beats/min, respiratory rate was 20/min, and body temperature was 37.0ºC. His abdomen was diffusely distended with normal bowel sounds. However, the patient had an exit-site infection with purulent secretion. The laboratory findings showed PD peritonitis: the white blood cell (WBC) count of the peritoneal effluents was 1157/mm3 with a neutrophil predominance (91.3%). His hemoglobin was 10.0 g/dl, WBC count was 9.1 x 109/L, and C-reactive protein was 2.50 mg/dl. After peritoneal fluid was sent for bacterial culture, a single 1-g dose of cefazolin and a single 1-g dose of ceftazidime were given intraperitoneally per day. Two peritoneal fluid samples were inoculated into a BACTEC plus Aerobic/F culture bottle (Becton Dickinson Diagnostic Instrument System, Drogheda, Ireland) and incubated in a BACT/ALERT 3D Blood Culture System (Biomerieux, Marcy l`etoile, France). The peritoneal WBC decreased to 364/mm3, but the patient’s clinical condition did not improve on the fifth day after starting intraperitoneal cefazolin and ceftazidime. Culture of the peritoneal dialysate and the discharge from exit-site revealed Agromyces species, which was susceptible to penicillin, meropenem, imipenem, vancomycin, but resistant to ceftriaxone. Thus, we changed antibiotics to intraperitoneal vancomycin and meropenem on the 5th day. Despite the intraperitoneal antibiotics for 4 days, the patient’s abdominal pain persisted and the WBC count of the peritoneal effluents became elevated to 1368/mm3. Therefore, we decided to remove the Tenckhoff catheter and the patient was switched to hemodialysis on the 9th day. The culture of the PD catheter tip was negative. Vancomycin and imipenem was continued for another two weeks and the patient’s clinical condition improved. The patient has been maintained on hemodialysis after catheter removal. Conclusion: In summary, we report a case of PD-associated peritonitis caused by A. mediolanus that was cured after PD catheter removal and intravenous antibiotic therapy. The identification of A. mediolanus was performed by matrix-assisted laser desorption ionization–time of flight mass spectrometry
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