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논문분류	춘계학술대회 초록집
제목	Continuous ambulatory peritoneal dialysis (CAPD) peritonitis with severe bowel edema caused by Morganella morganii
저자	Jun Young Lee, Byoung Geun Han, Jae Won Yang, Seung Ok Choi
출판정보	2018; 2018(1):
키워드	CAPD \| maorganella \| morganii
초록	Case Study: A-65-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and turbid peritoneal fluid. He presented ongoing constipation for 5 days. The paitent had been on CAPD for 2 years with one episode of peritonitis (caused by Enterobacter agglomerans 22 month ago). He had past history of liver cirrhosis, B viral hepatitis, type 2 diabetes and coronary artery disease. On presenation, he was afebrile, with a blood pressure of 80/50 mmHg. Abdominal examination showed diffuse generallized tenderness, associated with decreased bowel sound and diffuse abdominal wall edema. No expressible infection sign was observed the catheter exit site. The white blood cell (WBC) count was 1,1090 cells/μL, C-reactive protein level was 8.98 mg/dl and the WBC count of the peritoneal fluid was 5,950 cells/ml (with 76% polymorphonuclear nutrophills (PMN)), suggesting acute CAPD peritonitis. Emperic antibiotic therapy for PD-associated peritonitis was initiated with intraperitoneal (IP) cefazolin and amikacin. Initial culture form peritoneal fluid grew Morganella morganii sensitivity to piperacillin/tazobactam, ceftazidime, amikacin, ciprofloxacin and so on. Peritoneal fluid leukocyte count decreased to 356 cells/μL on hospital day 2. However, on 3rd hospital day peritoneal WBC count increased 1,270 cells/μL (78% PMN) and abdominal pain consisted without any improvement. Computer tomography showed severe bowel edema. We chnaged antibiotics to ceftazidime and amikacin following culture result. On 11 hospital day WBC count decreased to 7 cells/μL and there was no growth in peritoneal fluid culture. After 3 weeks of anitibiotics and fluid therapy patients was discharged. culture
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