大肠埃希菌和屎肠球菌致腹膜透析前腹膜炎一例

A Case of Escherichia coli and Enterococcus faecium-Associated Peritonitis before Peritoneal Dialysis

腹膜透析相关性腹膜炎是腹膜透析技术失败的主要原因之一,其中大肠埃希菌和屎肠球菌所致腹膜炎病情更严重,预后更差,通常导致较高的治疗失败率。本例女性患者基础病为IgA肾病,因肌酐升高,外院中医中药治疗3周后渐出现全身皮疹、颜面部及双下肢水肿、发热十余天。入我院后给予腹膜透析置管,术中引流腹腔积液呈深黄色浑浊液体,腹水及尿培养示大肠埃希菌和屎肠球菌。根据检查化验、培养结果,先后调整抗生素万古霉素、美罗培南等静脉及腹腔用药,给予透析、运动、营养、心理、皮肤护理、健康宣教等综合精细积极对症支持治疗、护理后,患者皮疹消褪、体温正常、腹水常规正常。

Peritoneal dialysis related peritonitis is one of the main reasons for the failure of peritoneal dialysis technology. The peritonitis caused by Escherichia coli and Enterococcus faecium is more serious and the prognosis is worse, which usually leads to a higher treatment failure rate. The basic disease of this female patient is IgA nephropathy. Due to the elevated creatinine, after 3 weeks of treatment with traditional Chinese medicine in another hospital, she gradually developed systemic rash, facial and lower limb edema, and fever for more than 10 days. After entering our hospital, peritoneal di-alysis was given and catheters were placed. During the operation, peritoneal effusion was drained as dark yellow turbid liquid. Ascites and urine culture showed Escherichia coli and Enterococcus faecium. According to the test and culture results, the intravenous and intraperitoneal drugs such as vancomycin and meropenem were adjusted successively, and the patients’ skin rash subsided, their body temperature was normal, and their ascites were normal after giving comprehensive and fine symptomatic support treatment and care such as dialysis, exercise, nutrition, psychology, skin care, health education.