Context

Pyocystis is an infection of the epithelium of the bladder and a frequent complication of anuria. Patients with spinal cord injury (SCI) at the sixth thoracic vertebra (T6) or higher are at a greater risk for autonomic dysreflexia (AD), which can be induced by infections such as pyocystis. Cases of pyocystis treatment with aminoglycoside instillations have been reported in the literature.

Findings

We describe the case of a 59-year-old male with T1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A complete paraplegia, status post bilateral nephrectomy with recurrent episodes of AD suspected to be caused by pyocystis related to anuria. A bladder specimen culture grew Escherichia coli susceptible to amikacin with a minimum inhibitory concentration (MIC) of ≤ 8 mg/L. In the setting of anuria and with concern that intravenous antibiotics would not adequately reach the site of infection, we chose to treat the patient with a single-dose intravesical instillation of amikacin 25 mg/100 mL left to dwell for approximately 2 h. A repeat bladder culture showed no colonies. The patient remained stable with no episodes of AD and no signs or symptoms of infection one month following treatment.

Conclusion

The purpose of this case report is to add to the current literature on intravesical aminoglycoside instillations for pyocystis to aid clinicians in treating future cases, as well as to highlight pyocystis as a potential cause of AD in SCI patients with anuria.

中文翻译：

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单剂量阿米卡星膀胱内滴注治疗自主神经反射异常患者脓囊肿：病例报告

语境

脓囊肿是膀胱上皮细胞的感染，是无尿症的常见并发症。第六胸椎 (T6) 或更高部位的脊髓损伤 (SCI) 患者发生自主神经反射异常 (AD) 的风险更大，这可能由脓囊肿等感染引起。文献报道了用氨基糖苷类滴注治疗脓囊肿的病例。

发现

我们描述了一名 59 岁男性的病例，他患有 T1 美国脊髓损伤协会 (ASIA) 损伤量表 (AIS) A 级完全性截瘫，双侧肾切除术后状态反复发作的 AD 疑似由与无尿相关的脓囊肿引起。膀胱标本培养物中生长出对阿米卡星敏感的大肠杆菌，其最小抑菌浓度 (MIC) ≤ 8 mg/L。在无尿的情况下，由于担心静脉内抗生素无法充分到达感染部位，我们选择对患者进行单剂量阿米卡星 25 mg/100 mL 膀胱内滴注，静置约 2 小时。重复膀胱培养显示无菌落。患者在治疗一个月后保持稳定，没有 AD 发作，也没有感染的体征或症状。

结论

本病例报告的目的是补充目前关于脓囊肿膀胱内氨基糖苷类滴注的文献，以帮助临床医生治疗未来的病例，并强调脓囊肿是无尿 SCI 患者 AD 的潜在原因。