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KMID : 0359920060250050857
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Korean Journal of Nephrology
2006 Volume.25 No. 5 p.857 ~ p.861
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A Case of Peritonitis due to Listeria Monocytogenes Pomplicating on Continuous Ambulatory Peritonial Dialysis Patient
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Joo Moon-Kyung
Ko Gang-Jee
Cho Won-Yong
Kim Hyung-Kyu
Kwon Bo-Sung
Jang Jin-Su
Park Jae-Youn
Kim Seung-Young
Kim Jin-Nam
Roh Kyong-Ho
Cho Yun-Jung
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Abstract
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Peritonitis in continuous ambulatory peritoneal dialysis is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed infection and fungal infection actively involved in the order named. Coagulate-negative Staphylococcus, Streptococcus, Staphylococcus aureus and Enterococcus cause most of the gram positive bacterial infections, and cases with other pathogens are very rare. We hereby report a case of peritonitis by Listeria Monocytogenes that was not responsive to the usual antibiotics for CAPD-associated peritonitis. A 58-year-old male who has been treated with CAPD for 17 years visited our hospital for abdominal pain, fever and turbid peritoneal fluid. He was diagnosed as diabetes mellitus 20 years ago. White blood cell and neutrophil count increased at the initial peritoneal fluid analysis, so we diagnosed him as CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of cefazolin/ tobramycin, which were soon changed to vancomycin/ ceftazidime. However, vancomycin/ceftazidime regimen was also proven ineffective. On the sixth hospital day, L. Monocytogenes was cultured in the peritoneal fluid sampled on the first visiting day. So we accordingly changed the antibiotics for ampicillin/ sulbactam, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in immunosuppressive patients such as the elderly, caused either by diabetes or by taking immunosuppressive agent, if they do not respond to the usual antibiotics, we should consider the possible infection by unusual pathogens. Gram positive rod in peritoneal fluid is a supporting evidence of peritonitis by L. monocytogenes. (Korean J Nephrol 2006;25(5):857-861)
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KEYWORD
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Peritonitis, Listeria monocytogenes, Continuous ambulatory peritoneal dialysis
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