腹腔鏡補助下子宮筋腫核出術後にMycoplasma hominisによる腹腔内膿瘍・菌血症を来した1例

抄録

  Gynecologic postoperative infections are expected to be due to aerobic gram-positive and gram-negative bacteria, anaerobic bacteria, Klebsiella pneumoniae, Streptococcus, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. In this case, we unexpectedly experienced the case of a patient with postoperative infection with Mycoplasma hominis. Measurements of this bacteria can result in false negatives in routine bacterial culture tests, and effective antibiotics are limited. Because it is difficult to identify and could lead to delayed treatment and aggravation, we report this case along with a literature review in order to increase awareness of this bacterium. A 37-year-old woman with uterine leiomyoma and endometriosis underwent laparoscopic-assisted myomectomy and left cystectomy. The intraoperative antibiotic was cefmetazole sodium (CMZ). Beginning the night of postoperative day (POD) 2, she developed a fever of 38°C. On POD 3, the fever worsened. Blood cultures were collected, and CMZ administration was initiated. On POD 6, we decided that the dose was insufficient. We increased the dose of CMZ and added metronidazole. Abdominal computed tomography (CT) suggested the presence of an abscess around the uterus. On POD 7, a catheter was placed in the abscess under CT guidance. On POD 8, the fever did not improve. We collected blood cultures and changed the antibiotics to tazobactam. After that, the fever appeared to improve. However, it recurred on POD 12. On the night of POD 13, Mycoplasma hominis was identified in the abscess culture. On POD 14, we changed the antibiotics to clindamycin and levofloxacin. The fever rapidly reduced, and the C-reactive protein level became negative. On POD 20, she was discharged. Later, the same bacteria were identified from blood cultures.