Necrotizing Fasciitis Caused by Serratia Marcescens in a Patient with Peritoneal Dialysis: A Case Report and Review of Literature

長期腹膜透析的病人發生Serratia marcescens壞死性筋膜炎：一病例報告及文獻整理

方昱偉(Yu-Wei Fang) ； 張宗興(Chung-Hsin Chang)

《Acta Nephrologica》 21卷1期 (2007/03) Pp. 58-60

摘要

壞死性筋膜炎是一種進展快速，而且死亡率極高的軟組織感染。一般而言，造成蜂窩性組織炎及其他軟組織感染的菌種多半是以葛蘭氏陽性菌為主，但在免疫功能不全的病人身上則以葛蘭氏陰性菌較為常見。在過去的文獻資料中，以壞死性筋膜炎來表現的Serratia marcescens感染是十分罕見的。我們報告一例62歲接受長期腹膜透析的男性病人發生嚴重Serratia marcescens感染所導致的壞死性筋膜炎，藉由早期抗生素治療，合併外科手術清瘡，而成功治療的案例，藉以提醒臨床醫師對於免疫功能不全的病人發生軟組織感染時，需考慮葛蘭氏陰性菌的可能性。

關鍵字

粘質沙雷氏菌 ； 壞死性筋膜炎 ； 末期腎病 ； 腹膜透析 ； 免疫功能不全

並列摘要

Necrotizing fasciitis is a rapidly progressive and destructive infection of the subcutaneous tissue. In immunocompromised host, this cutaneous infection is associated with high morbidity and mortality. The major pathogen causing necrotizing fasciitis is the Gram-positive bacteria. However, in immunocompromised persons, Gram-negative organisms are found more frequently. We report an unusual case of community-acquired necrotizing fasciitis caused by Serratia marcescens progressed to bacteremia in a patient with end-stage renal disease undergoing regular peritoneal dialysis for 8 years. After antibiotics adjustment from oxacillin to cefepime for two weeks and serial debridement, the infection was under control and he was discharged in stable condition.

並列關鍵字

Serratia marcescens ； necrotizing fasciitis ； end-stage renal disease ； peritoneal dialysis ； immunocompromised host