棲稻假單胞菌感染所致腹膜透析相關腹膜炎：案例報告與文獻回顧

Pseudomonas oryzihabitans Causes Peritonitis in a Patient with Peritoneal Dialysis: A Case Report and Literature Review

Pseudomonas oryzihabitans是一種腐生性的非發酵革蘭氏陰性桿菌，棲息在稻田等潮濕環境中。我們描述了一例76歲男性腹膜透析患者出現腹痛、發熱和低血壓的病例。入院時理學檢查和實驗室檢查均與腹膜炎的診斷一致。腹膜透析液中培養並鑑定出P. oryzihabitans。此株細菌對於許多抗生素具有敏感性，包括gentamicin、amikacin、levofloxacin、ceftazidime、cefepime、ceftriaxone、meropenem、imipenem、piperacillin-tazobactam，以及trimethoprim-sulfamethoxazole。開始的治療是使用腹膜內投與ceftazidime，但是臨床效果並不如預期。加上合併使用的ciprofloxacin後，腹膜炎相關的症狀隨即緩解而治療成功。據我們的文獻回顧結果，在我們的病例之前，僅有八個案例被報導過。P. oryzihabitans造成的腹膜透析相關腹膜炎在病程比綠膿桿菌輕微，預後也較好。使用兩種有效的抗生素治療3周則是建議的治療方式。

Pseudomonas oryzihabitans is a saprophytic, non-fermentative, Gram-negative bacillus, which inhabits humid environments such as rice paddy fields. This study describes a case of a 76-year-old male with peritoneal dialysis who presented with abdominal pain, fever and hypotension. Initial symptoms, physical examination and laboratory tests were consistent with a diagnosis of peritonitis. The P. oryzihabitans was isolated and identified from the ascites. The P. oryzihabitans was susceptible to most antibiotics, including gentamicin, amikacin, levofloxacin, ceftazidime, cefepime, ceftriaxone, meropenem, imipenem, piperacillin-tazobactam and trimethoprim-sulfamethoxazole.
Intraperitoneal ceftazidime was administrated as a treatment when culture and antimicrobial susceptibility test results became available, but the clinical response was not as expected. After adding ciprofloxacin, peritonitis was resolved uneventfully. To the authors’best knowledge, eight other cases have been reported previously. A milder clinical severity and more favorable treatment outcomes than those caused by P. aeruginosa and two antipseudomonal antibiotics for 3 weeks are recommended for the treatment of P. oryzihabitans peritonitis. The aminoglycosides and quinolones are superior choices to other antipseudomonal agents.