Case Report

Tatalaksana peritonitis bakteri Staphylococcus Epidermidis pada seorang pasien dengan continuous ambulatory peritoneal dialysis (CAPD)

I Gusti Agung Ayu Indira Nirmala Dewi , Yenny Kandarini

I Gusti Agung Ayu Indira Nirmala Dewi
Program Studi Pendidikan Dokter Spesialis Penyakit Dalam Fakultas Kedokteran Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia. Email: indira.amrita@gmail.com

Yenny Kandarini
Departemen/ KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Sanglah, Denpasar, Bali, Indonesia
Online First: August 01, 2020 | Cite this Article
Dewi, I., Kandarini, Y. 2020. Tatalaksana peritonitis bakteri Staphylococcus Epidermidis pada seorang pasien dengan continuous ambulatory peritoneal dialysis (CAPD). Intisari Sains Medis 11(2): 504-510. DOI:10.15562/ism.v11i2.642


Background: Peritonitis is a common CAPD related infection. It can cause discontinue dyalisis peritoneal and conversion to hemodyalisis.

Case description: This article reported a 54-year-old man on 5 years dialysis peritoneal with a complaint of abdominal pain since 1 week before admission. The complaint accompanied by fever and nausea. On abdominal examination there are mild distention, weak of bowel sound, pressure pain, and defans muscular. Dialisat examination found cloudy fluid, effluent white blood cell count 961 cells/mm3 composed of 85% polymorphonuclear leucocytes. Peritoneal dialysis effluent gram stain, routine culture found isolated Staphylococcus epidermidis with methicillin resistant, significant as infectious agent depend on patient’s clinical and infection’s marker. Performed a definitive antibiotic with Linezolid 600 miligram intravena and Gentamicin 40 miligram intraperitoneal during 14 days showed clinical and laboratorium improvement.

Conclusion: Peritonitis remains a major cause of technique failure in peritoneal dialysis and affects patient’s morbidity and mortality. Management should be definitive antibiotic as dialysat culture result. Catheter removal indicated if there were refractory peritonitis, relapsing peritonitis, refractory exit-site and tunnel infection, fungal peritonitis.

 

Latar belakang: Peritonitis merupakan komplikasi infeksi pada pasien CAPD yang umum terjadi. Peritonitis dapat menjadi penyebab utama penghentian dialisis peritoneal dan dikonversi ke hemodialisis.

Deskripsi kasus: Laporan kasus ini melaporkan laki-laki berusia 54 tahun yang telah menjalani CAPD selama 5 tahun mengeluh nyeri perut sejak 1 minggu yang lalu SMRS. Nyeri perut disertai dengan demam dan mual. Pemeriksaan abdomen didapatkan distensi ringan, bising usus terdengar lemah, adanya nyeri tekan, dan defans muskuler. Pemeriksaan analisis cairan dialisat didapatkan warna keruh/berawan dengan jumlah  961 sel/uL dengan dominan polymononuklear sebesar 85%. Pemeriksaan kultur/ biakan cairan peritoneum didapatkan terisolasi bakteri Staphylococcus epidermidis yang bersifat Methicillin resistant, significan sebagai agen penyebab infeksi tergantung keadaan klinis dan marker infeksi pasien. Dilakukan tatalaksana terapi antibiotik definitif dengan Linezolid 600 miligram setiap 12 jam intravena dan Gentamicin 40 miligram intraperitoneal, intermiten dose saat penggantian cairan malam hari. Pemberian terapi antibiotik definitif dan intraperitoneal dilanjutkan selama 14 hari dan pada pasien didapatkan perbaikan secara klinis dan laboratorium.

Simpulan: Peritonitis merupakan penyebab utama kegagalan teknik pada dialisis peritoneal dan mempengaruhi morbiditas serta mortalitas pasien CAPD. Diagnosis peritonitis terkait CAPD sedini mungkin serta pemberian terapi yang cepat dan tepat dapat menghindarkan pasien dari komplikasi yang lebih berat dan kegagalan dialisis peritoneal.

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