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논문분류	춘계학술대회 초록집
제목	AUTOMATED PERITONEAL DIALYSIS-RELATED PERITONITIS CAUSED BY COINFECTION WITH MORGANELLA MORGANII AND CORYNEBACTERIUM SPECIES
저자	Kyeong min KIM, *Kitae BANG
출판정보	2017; 2017(1):
키워드	Peritoneal diaysis, Morganella morganii, CORYNEBACTERIUM SPECIES
초록	Case Study : A Peritoneal dialysis (PD) related infection is the most common and serious complication in patients undergoing peritoneal dialysis. Morganella morganii (M. Morganii) is a Gram-negative rod that is part of the normal flora of the intestinal tract in humans and other animals. However, M. Morganii is a rare cause of PD-related peritonitis. This case is the fifth PD-related peritonitis case due to M. morganii and the first case of APD related peritonitis by either M. morganii and of PD-related peritonitis by co-infection of by M. morganii and Corynebacterium species so far reported in the literature. Also, this is the first report of peritonitis due to M. morganii in Republic of Korea. We herein report a case of M. Morganii and Corynebacterium species co-infection in a patient with peritonitis. A 78-year-old woman with end-stage renal disease secondary to diabetes mellitus on APD admitted with abdominal pain and cloudy peritoneal fluid. Five years before admission, CAPD was initiated for end-stage renal disease and switched to APD 3 years before. On physical examination, Her blood pressure was 130/70 mmHg, her heart rate was 88 beats/min, her respiratory rate was 20 breaths/ min and; her temperature was 37.4℃. A laboratory investigation revealed the following findings: hemoglobin = 9.9 g/dL; white blood cell count (WBC)= 9,490/mm3 with 82% polymorphonuclear cells; C-reactive protein = 10.1mg/dL. A physical examination revealed a remarkable level of abdominal tenderness. The effluent peritoneal fluid was cloudy, with a WBC count of 11,500/mm3 (predominantly polymorphonuclear cells). After performing a peritoneal fluid culture, the patient was treated with intraperitoneal (IP) antibiotics, specifically ceftazidime and cefazolin. Two days after the start of antibiotic therapy, the patient’s abdominal pain subsided and the peritoneal fluid became clear. On hospital day 4, a culture of the peritoneal fluid obtained on admission day revealed M. Morganii which was sensitive to ciprofloxacin and ceftazidime and piperacillin/tazobactam and resistant to cefazolin and amoxicillin. As a result, the antibiotic regimen was switched to IP ceftazidime alone. Treatment with IP ceftazidime was continued, and the patient was discharge on hospital day 5. Although IP antibiotics injection had lasted in the home, however, on 9th day after discharge, effluent peritoneal fluid became cloudy again. Further laboratory tests showed an elevated CRP level, leukocytosis and peritoneal WBC count. We considered the antibiotic treatment to have failed due to bacterial colonization of the surface of the peritoneal Tenckhoff catheter. Therefore, we decided to remove the catheter, and switch the treatment regimen to hemodialysis. Consequently, A culture of the peritoneal fluid revealed organisms initially identified as Gram-positive rods, later identified as Corynebacterium species, which was sensitive to vancomycin and teicoplanin and resistant to oxacillin and ciprofloxacin. The IP antibiotics were discontinued and vancomycin was administered intravenously for an additional two weeks, while the patient continued to remain asymptomatic. M. Morganii is a rare cause of PD-related peritonitis, and our patient may be first case of APD related peritonitis by M. morganii and of PD-related peritonitis by co-infection of by M. morganii and Corynebacterium species.
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