Case Report The Korean Journal of Pancreas and Biliary Tract 2014;19:189-193 http://dx.doi.org/10.15279/kpba.2014.19.4.189 pissn 1976-3573 eissn 2288-0941 Stenotrophomonas maltophilia 균혈증에의해발생한급성담낭염 1 예 한림대학교의과대학내과학교실 이재은 김광택 유준재 김미강 최민호 장현주 계세협 이진 A Case of Acute Cholecystitis Caused by Stenotrophomonas maltophilia Bacteremia Jae Eun Lee, Kwang Taek Kim, Jun Jae Yoo, Mi Kang Kim, Min Ho Choi, Hyun Joo Jang, Sea Hyub Kae, Jin Lee Department of Internal Medicine, College of Medicine Hallym University, Hwaseong, Korea Stenotrophomonas maltophilia is an ubiquitous aerobic Gram-negative bacillus. Hospitalization and prior antibiotic therapy are risk factors for S. maltophilia infection. This organism is isolated with increasing frequency from hospitalized patients and may cause therapeutic problems because of its intrinsic resistance to common antibiotics and the immunodeficiency status of the affected host. S. maltophilia has been reported to be commonly associated with pneumonia and urinary tract infection. However, biliary infection caused by S. maltophilia is very rare. Herein, we report on a case of acute cholecystitis that developed secondary to S. maltophilia bacteremia in a patient with hepatitis-b related liver cirrhosis and gallbladder stone. Keywords: Stenotrophomonas maltophilia, Bacteremia, Acute cholecystitis, Liver cirrhosis Received Apr. 17, 2014 Revised Jul. 23, 2014 Accepted Jul. 30, 2014 Corresponding author : Jin Lee Department of internal medicine, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebonggil (40, Seoku-dong), Hwaseong 445-907, Korea Tel. +82-31-8086-2450 Fax. +82-31-8086-2029 E-mail; jinlee@hallym.or.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2014 by The Korean Journal of Pancreas and Biliary Tract 서론 Stenotrophomonas maltophilia ( S. maltophilia) 1960 Pseudomonas maltophilia 1983 Xanthomonas, 1993 Stenotrophomonas. 1,2,,,,,,, (nebulizer). 3,4,,,,,,,,,,,. S. maltophilia Copyright 2014 by Korean Pancreatobiliary Association 189
A Case of Acute Cholecystitis Caused by Stenotrophomonas maltophilia Bacteremia,. 5,6 B S. maltophilia. 증례 55 10. 13 B,, 3 2 (entecavir 0.5 mg) 7. 3,. 20, 3. 10,.,,. 3,420/mm 3, 14.3 g/dl, 43.8%, 76,000/mm 3, AST 920 IU/L, ALT 1,190 IU/L, 10.4 mg/dl, 8.3 mg/dl, ALP 97 IU/L, r-gt 572 IU/L, 5.3 g/dl, 3.1 g/dl, 195 mg/dl, BUN 9.6 mg/dl, 0.7 mg/dl, 15.6 (INR 1.37), (aptt) 34.7. HBV-DNA 1 <116 copies/ml 117,260,522 copies/ml, HBeAg, anti-hbe. (Fig. 1). B, (entecavir 0.5 mg). AST 60 IU/L, ALT 105 IU/L, 7.9 mg/dl, 5.3 mg/dl Fig. 1. Abdominal ultrasonography shows multiple calcified gallstones and diffusely edematous gallbladder wall thickening without distension.. 14 39, (murphy s sign). (Fig. 2),,. B Cefotaxime metronidazole,. 3 S. maltophilia S. maltophilia 19. ticarcillin/clavulanate, trimethoprim/sulfamethoxazole (TMP/SMX), ceftazidime, ciprofloxacin, levofloxacin, cefotaxime, piperacillin, cefepime, gentamicin, amikacin, imipenem, tobramycin ceftazidime levofloxacin.., AST 21 IU/L, ALT 19 IU/L, 2.5 mg/dl, 2.1 mg/dl, 12.8 (INR 1.12).. 190 http://dx.doi.org/10.15279/kpba.2014.19.4.189
Jae Eun Lee, et al. A Fig. 2. Abdominal CT scan shows fat infiltration with rim-enhancing lesion, edematous wall thickening and slightly distension of gallbladder with multiple calcified gallstones. Dilatation of the biliary duct is not evident(a: pre-enhance phase, B: portal phase). B 고찰 Escherichia coli, Enterococcus, Klebsiella, Proteus, Bacterides, Clostridium. methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), Pseudomonas spp.,,,. 7-10 B (entecavir 0.5 mg), S. maltophilia S. maltophilia. S. maltophilia,,.,,,,,. 1-6 S. maltophilia, 11,12 (pseudo-out-break). 13,, S. maltophilia 6 S. maltophilia, 14 S. maltophilia, 15 S. maltophilia. S. maltophilia,. 5,6 22-63%,,,,. 16,17, 18 20 S. maltophilia, 191
A Case of Acute Cholecystitis Caused by Stenotrophomonas maltophilia Bacteremia. S. maltophilia,,,,,. 5,18 S. maltophilia (drug hydrolyzing enzyme). betalactam, (aminoglycoside) cephalosporin, monobactam, antipseudomonal penicillins, imipenem, quinolone, 1 trimethoprim-sulfamethoxazole (TMP-SMX). 18-21 B S. maltophilia S. maltophilia. B S. maltophilia 1. 요약 S. maltophilia.,,.,. B B S. maltophilia 1. 국문색인 : Stenotrophomonas maltophilia, 균혈증, 급성담낭염, 간경변 Conflicts of Interest The author has no conflicts to disclose. REFERENCES 1. Hugh R, Ryschenkow E. Pseudomonas maltophilia, an alcaligenes-like species. J Gen Microbiol 1961;26:123-132. 2. Palleroni NJ, Bradbury JF. Stenotrophomonas, a new bacterial genus for Xanthomonas maltophilia (Hugh 1980) Swings et al. 1983. Int J Syst Bacteriol 1993;43:606-609. 3. Stanier RY, Palleroni NJ, Doudoroff M. The aerobic pseudomonads: a taxonomic study. J Gen Microbiol 1966;43:159-271. 4. Gilardi GL. Pseudomonas maltophilia infections in man. Am J Clin Pathol 1969;51:58-61. 5. Bin Abdulhak AA, Zimmerman V, Al Beirouti BT, Baddour LM, Tleyjeh IM. Stenotrophomonas maltophilia infections of intact skin: a systematic review of the literature. Diagn Microbiol Infect Dis 2009;63:330-333. 6. Downhour NP, Petersen EA, Krueger TS, Tangella KV, Nix DE. Severe cellulitis/myositis caused by Stenotrophomonas maltophilia. Ann Pharmacother 2002;36:63-66. 7. Brismar B, Jalakas K, Malmborg AS, Strandberg A. The significance of bacteriological findings at cholecystectomy. Acta Chir Scand Suppl 1986;530:35-38. 8. Jarvinen HJ. Biliary bacteremia at various stages of acute cholecystitis. Acta Chir Scand 1980;146:427-430. 9. Kim CG, Yoon SY, Bang CD. A clinical observation of the surgical biliary tract disease. J Korean Surg Soc 1984;27:605-616. 10. Bae WK, Moon YS, Kim JH, et al. Microbiologic study of the bile culture and antimicrobial susceptibility in patients with biliary tract infection. Korean J Gastroenterol 2008;51:248-254. 11. Aguilar I, Palacios R, Garcia V, Santos J. Stenotrophomonas maltophilia bacteremia after endoscopic retrograde cholangiopancreatography. Enferm Infecc Microbiol Clin 2006;24:475. 12. Ducki S, Croize J, Mallaret MR. Stenotrophomonas maltophilia bacteremia after endoscopic retrograde cholangiopancreatography. Gastroenterol Clin Biol 2008;32:784-786. 13. Ahn GY, Yu FN, Jang SJ, et al. Pseudo-outbreak of Stenotrophomonas maltophilia due to contamination of bronchoscope. Korean J Lab Med 2007;27:205-209. 14. Lee WU, Kim BJ, Ahn US, et al. Clinical Features of Stenotrophomonas Maltaphilia Infection. Korean J Med 1997;53:352-358. 192 http://dx.doi.org/10.15279/kpba.2014.19.4.189
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