利用mNGS成功诊治多形拟杆菌致难治性腹膜透析腹膜炎一例  

Successful diagnosis and treatment of refractory peritonitis caused by Bacteroides thetaiotaomicron by high-throughput sequencing:a case report

作　　者：卢东丽 刘同换 王立新[2] 林俊杰[2] Lu Dongli;Liu Tonghuan;Wang Lixin;Lin Junjie(The Second Clinical School of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;不详)

机构地区：[1]广州中医药大学第二临床医学院,广州510006 [2]广东省中医院芳村医院肾内科,广州510370

出　　处：《新医学》2022年第6期453-456,共4页Journal of New Medicine

基　　金：广东省中医药局科研项目(20201162)。

摘　　要：腹膜透析相关性腹膜炎是腹膜透析患者常见的并发症之一,但是厌氧菌感染所导致的腹膜炎较少见。该文报道了一例44岁女性患者,维持性腹膜透析4年余,因腹痛腹泻、腹膜透析液浑浊并被诊断为腹膜透析相关性腹膜炎收入院。该例患者的多次腹膜透析液培养结果均呈阴性,经验性抗感染治疗后无效,考虑为难治性腹膜透析相关性腹膜炎,最终经基于宏基因组二代测序(mNGS)技术病原学检查提示存在多形拟杆菌感染,并使用甲硝唑联合亚胺培南西司他丁钠抗感染,18 d后患者痊愈出院,随访至今未见腹膜炎复发或再发。该例诊治过程提示,应重视厌氧菌感染导致的腹膜透析相关性腹膜炎,可考虑将mNGS技术应用于常规腹膜透析相关性腹膜炎的检查,以提高病原微生物的检出率,并根据检测结果尽早选用合适的抗生素进行抗感染治疗,改善患者预后。Peritoneal dialysis-related peritonitis is a common complication of patients receiving peritoneal dialysis.However,peritonitis caused by anaerobic infection is rare.This article was reported a 44-year-old female patient who had undergone maintenance peritoneal dialysis for more than 4 years.She was admitted due to abdominal pain,diarrhea,and turbid peritoneal fluid after being diagnosed with peritoneal dialysis-related peritonitis.Repeated peritoneal fluid culture tests yielded negative results.After ineffective anti-infection treatment,the possibility of peritoneal dialysis-related refractory peritonitis was considered.Metagenomic next-generation sequencing(mNGS)pathogenic examination revealed the presence of Bacteroides thetaiotaomicron infection.She was recovered and discharged after combined use of metronidazole combined with imipenem and cilastatin sodium for 18 d.No recurrence of peritonitis was observed during follow-up.The diagnosis and treatment of this case prompt that attention should be paid to peritoneal dialysisrelated peritonitis caused by anaerobic bacterial infection.mNGS can be applied in the routine examination of peritoneal dialysis-related peritonitis,aiming to improve the detection rate of pathogenic microorganisms,promptly select appropriate antibiotics for anti-infection therapy and enhance clinical prognosis of patients.

关 键 词：腹膜透析相关性腹膜炎 多形拟杆菌 厌氧菌 基于宏基因组二代测序 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]