Title

Life-Threatening Arteriovenous Graft Infection in a Patient on Hemodialysis: Septic Pulmonary Emboli and Left Sided Endocarditis

Translated Titles

透析病患動靜脈瘻管的致命性感染:敗血性肺栓塞與左側心內膜炎-病例報告

Authors

施孟甫(Meng-Fu Shih);陳培然(Pei-Jan Chen);郭靖海(Ching-Hai Kuo);彭明仁(Ming-Jen Peng);陳漢湘(Han-Hsiang Chen);吳志仁(Chih-Jen Wu)

Key Words

血液透析 ; 動靜脈 ; 管感染 ; 敗血性肺栓塞 ; 葡萄球菌菌血症 ; 心內膜炎 ; hemodialysis ; arteriovenous graft infection ; pulmonary septic emboli ; staphylococcal bacteremia ; infective endocarditis ; mitral valve

PublicationName

Acta Nephrologica

Volume or Term/Year and Month of Publication

18卷2期(2004 / 05 / 25)

Page #

80 - 83

Content Language

英文

Chinese Abstract

對長期血液透析病患而言,血管通路是主要細菌進入人體的途徑,尤其是金黃色葡萄球菌(Staphylococcus aureus)。儘管給予積極的治療,這些血管通路所引起的相關敗血症與栓塞仍引起極高的死亡率與致病率。絕大多數的敗血性肺栓塞都由右側心內膜炎而來,敗血性肺栓塞併發左側心內膜炎是相當罕見的。本篇報告一位糖尿病引發末期腎病變接受規則血液透析的病患,因為人工血管通路感染住進本院,初期表現為多發性敗血性肺栓塞合併開洞,血液細菌培養結果為對盤尼西林有抗藥性之金黃色葡萄球菌(methicillin-resistant Staphylococcus aureus MRSA)經過抗生素治療一週後,因出現心臟衰竭現象與持續發燒加上理學檢查有新出現的收縮期心雜音,心臟超音波發現左側僧帽瓣有贅生物。儘管給予更積極的抗生素治療,病患終因敗血性休克死亡。 對長期透析病患的血管通路感染,我們應該對可能會有不只一個地方的後續感染保持高度的警戒心。心臟超音波應該在懷疑可能有心內膜炎的情況下儘早安排,以及早治療。此外,有文獻報告指出,如果病患情況持續惡化,可以考慮暫時將血液透析轉成腹膜透析,以避免反覆的穿刺植入暫時性血管通路與直接的血液接觸,可能造成繼發持續性的感染,但目前尚未有定論,仍待更多研究來證實。

English Abstract

In patients on maintenance hemodialysis (HD), vascular access remains the major port of entry for bacteria, especially Staphylococcus aureus. Access-line related sepsis and embolic complications cause high morbidity and mortality in these patients despite appropriate treatment. The combination of septic pulmonary emboli and left-sided infective endocarditis is very rare in patients on HD. We reported a patient with diabetes on regular HD who developed a graft infection. Within one week, he had bilateral septic pulmonary emboli. Subsequently, he was found to have a mitral valve vegetation. Even though he was treated with appropriate antibiotics, the infection was not eradicated, and the patient died. In patients on HD who develop a vascular access infection, we should maintain a high index of suspicion for more than one infection focus. Echocardiography should be performed to look for evidence of endocarditis. If the condition of the patients fails to improve, a temporary change to peritoneal dialysis may be helpful to prevent persistent bacteremia caused by the repeated puncture of the infected vascular graft.

Topic Category 醫藥衛生 > 內科