Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed microorganisms and fungi. The case of imipenem resistance Acinetobacter baumannii (IRAB) peritonitis are not common. We report a case of peritonitis by IRAB that was not responsive to the empirical antibiotics for CAPD-associated peritonitis. A 56-year-old male with a CAPD catheter inserted 2 weeks before visited our hospital for abdominal pain and turbid peritoneal fluid. He had been diagnosed as having an end stage renal disease (ESRD) about a month before. White blood cell and neutrophil count were elevated at the initial peritoneal fluid analysis, so we diagnosed him as having CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of ceftazidime/cefamezine which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen proved ineffective. On the fifth and sixth hospital day, IRAB was cultured from the CAPD catheter exit site swab and peritoneal fluid sampled on the first visiting day. Accordingly, we changed the antibiotics to colistin and removed the CAPD catheter, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in patients who have a history of ICU stay, exposure to the 3rd generation cephalosporin or imipenem, or who are elderly, we must suspect unusual pathogen or multi-drug resistance pathogen such as IRAB.
Abdominal Pain ; Acinetobacter ; Acinetobacter baumannii ; Aged ; Anti-Bacterial Agents ; Ascitic Fluid ; Catheters ; Colistin ; Drug Resistance, Multiple ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Injections, Intraperitoneal ; Kidney Failure, Chronic ; Leukocytes ; Male ; Middle Aged ; Neutrophils ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis

PURPOSE: The present study was aimed at evaluating the usefulness of box simulators for training novice endoscopists. MATERIALS AND METHODS: An explanation of the goals, contents, and features of the simulator was given to study participants. The participants then received "hands-on training" in gastrointestinal endoscopy techniques using a box simulator. Subsequently, they were asked to answer 19 structured questions about the simulator. Ratings were scored on a scale from 1 to 5 for questions concerning their first impression of the simulator. Questions on the usefulness of the simulator and the training course were answered as "agree", "disagree", or "no opinion". RESULTS: A total of 32 participants filled out the questionnaire. The mean scores on the simulator's usefulness, features, and realistic movements before the training were between 1.5 and 2.0. There were no significant differences between the mean values of the scores given by novice users compared to non-novice users. However, after receiving training on the simulator, 90.6% of the participants considered the box simulator a generally useful tool for learning basic endoscopic techniques, and 90.6% agreed that the simulator was useful for improving hand-eye coordination. CONCLUSION: Box simulators may be useful for training novice endoscopists in basic gastrointestinal endoscopic techniques.
*Computer Simulation ; Endoscopy/*education ; Endoscopy, Gastrointestinal/education ; Humans ; Questionnaires