Nosocomial Urinary Tract Infection Related Retroperitoneal Abscess with Internal Colonic Fistula

院內泌尿道感染併後腹腔膿瘍與續發性內瘺管

蔡適鴻(Shih-Hung Tsai) ； 張維洲(Wei-Chou Chang) ； 許金旺(Chin-Wang Hsu) ； 朱士傑(Shi-Jye Chu) ； 彭萬誠(Wann-Cherng Perng)

《重症醫學雜誌》 11卷4期 (2010/12) Pp. 275-279

https://doi.org/10.30035/TCCM.201012.0006

摘要

後腹腔膿瘍常常不能被及時診斷。我們報告一呼吸器依賴病患發生導管相關之泌尿道感染後合併後腹腔膿瘍，續發與降結腸相通的內瘺管。併發後腹腔膿瘍可以是泌尿道感染控制不良的因素而與腸道相通的瘺管及發生廣泛抗藥性的乙內醯胺酶的菌株皆使治療更爲複雜化。反覆的瘺管造影及細菌培養應有助於監測膿瘍侵犯的範圍；瘺管的癒合與否與否抗藥性菌株的生成。

關鍵字

後腹腔膿瘍 ； 泌尿道感染 ； 腸道瘺管 ； 抗藥性菌株 ； 院內感染 ； 克雷白氏菌 ； 萬古黴素抗藥性腸球菌

並列摘要

Retroperitoneal abscess may not be diagnosed timely occasionally. Here we report a patient who had nosocomial urinary tract infection related retroperitoneal abscess and subsequently developed a secondary internal fistula to the adjacent descending colon. Nosocomial UTI related retroperitoneal abscess can be a source of occult infection that responses poorly to antibiotic treatment. Retroperitoneal abscess can be further complicated with internal colonic fistula. Repeated fistulography and culture may be necessary to identify the extensiveness of the abscess cavity and the development of resistant strains. The presence of multiple drug resistance pathogens can perplex the treatment course and repeated drainage will be required.

並列關鍵字

Retroperitoneal abscess ； Urinary tract infection ； Nosocomial infections ； Colonic fistula ； Klebsiella ； Vancomycin-resistence enterocuccus