杰氏棒杆菌致临床患者尿路感染的临床分析
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摘要
目的探讨杰氏棒杆菌所致临床患者尿路感染的实验室检查、临床表现、治疗及相关文献分析。方法收集2016年11月尿液培养阳性标本,革兰氏染色观察细菌形态,采用Walkaway96全自动细菌鉴定仪、质谱仪、API 20棒鉴定细菌,E试验进行药敏试验。结果革兰阳性棒状杆菌可被白细胞吞噬及破坏白细胞,鉴定结果为杰氏棒杆菌,其对多种抗菌药物耐药。期间患者体温出现明显波动,复查血常规显示:白细胞14.6×109/L、尿常规白细胞++,调整为哌拉西林/他唑巴坦抗感染治疗。结论实验室工作人员应提高对革兰阳性棒杆菌的重视,正确指导临床采集标本,以免造成临床医师对重症患者继发疾病的漏诊。此外,万古霉素、利奈唑胺、替加环素可作为治疗杰氏棒杆菌感染的首选药物;哌拉西林/他唑巴坦临床治疗有效,可作为经验性用药的选择之一。
OBJECTIVE To explore the result of laboratory examination,clinical manifestations,treatment and literatures relating to urinary tract infection caused by Corynebacterium jeikeium.METHODS The urine specimens that were cultured positive were collected in Nov,2016,the bacterial morphological features were observed by using gram staining,the isolated strains were identified by using Walkaway96 automatic system,mass spectrometer and API20 coryne,and the drug susceptibility testing was performed by means of E-test.RESULTS The grampositive Corynebacterium strains could be engulfed by white blood cells and destroyed the white blood cell counts,the strains were identified as Corynebacterium jeikeium,which were multidrug-resistant.The body temperature of the patients showed obvious fluctuation during the period,and the result of blood routine reexamination indicated that the white blood cells counts were 14.6×109/L,urine routine WBC ++,and piperacillin-tazobactam was adjusted for treatment of the infection.CONCLUSIONIt is necessary for the laboratory personnel to attach great importance to the gram-positive Corynebacterium and provide guidance for standard clinical collection of specimens so as to avoid the missed diagnosis of secondary diseases,in addition,vancomycin,linezolid and tigecycline can be used as the preferred drugs for treatment of the Corynebacterium jeikeiuminfection,piperacillin-tazobactam is effective for clinical treatment and can be used for empirical drug therapy.
OBJECTIVE To explore the result of laboratory examination,clinical manifestations,treatment and literatures relating to urinary tract infection caused by Corynebacterium jeikeium.METHODS The urine specimens that were cultured positive were collected in Nov,2016,the bacterial morphological features were observed by using gram staining,the isolated strains were identified by using Walkaway96 automatic system,mass spectrometer and API20 coryne,and the drug susceptibility testing was performed by means of E-test.RESULTS The grampositive Corynebacterium strains could be engulfed by white blood cells and destroyed the white blood cell counts,the strains were identified as Corynebacterium jeikeium,which were multidrug-resistant.The body temperature of the patients showed obvious fluctuation during the period,and the result of blood routine reexamination indicated that the white blood cells counts were 14.6×109/L,urine routine WBC ++,and piperacillin-tazobactam was adjusted for treatment of the infection.CONCLUSIONIt is necessary for the laboratory personnel to attach great importance to the gram-positive Corynebacterium and provide guidance for standard clinical collection of specimens so as to avoid the missed diagnosis of secondary diseases,in addition,vancomycin,linezolid and tigecycline can be used as the preferred drugs for treatment of the Corynebacterium jeikeiuminfection,piperacillin-tazobactam is effective for clinical treatment and can be used for empirical drug therapy.
引文
[1]张勇.239株泌尿系感染病原菌的构成比与耐药性调查[J].中华医院感染学杂志,2011,21(5):1046-1047.
[2]邓法文.泌尿系感染病原菌分布及耐药性调查分析[J].中华医院感染学杂志,2012,22(17):3890-3892.
[3]Pitcher D,Johnson A,Allerberger F,et al.An investigation of nosocomial infection with Corynebacterium jeikeium in surgical patient using a ribosomal RNA gene probe[J].Eur J Clin Microbiol Infect Dis,1990,9(9):643-648.
[4]孙建平,何宏,张伟,等.临床表现隐匿的杰氏棒杆菌感染性心内膜炎一例[J].中华内科杂志,2016,55(4):325-326.
[5]霍颖鹏,黄朱亮.细菌16S核糖体RNA基因检测杰氏棒杆菌一株[J].中华诊断学电子杂志,2015,3(4):296-299.
[6]Cazanave C,Greenwood-Quaintance KE,Hanssen AD,et al.Corynebacterium prosthetic joint infection[J].J Clin Microbiol,2012,50(5):1518-1523.
[7]Bechara C,Gousseff M,Passeron A,et al.Corynebacterium jeikeium pacemaker infection associated with antineutrophil aytoplasmic antibodies:a single positive blood culture could be sufficient for diagnosis[J].J Med Microbiol,2011,60(Pt2):249-251.
[8]Ifantidou AM,Diamantidis MD,Tseliko G,et al.Corynebacterium jeikeium bacteremia in a hemodialyzed patient[J].Int J Infect Dis,2010,14(Suppl3):e265-268.
[9]Chao CT,Huang JW,Yen CJ.A rare and under-recognized pathogen in peritoneal dialysis peritonitis:Corynebacterium jeikeium[J].Perit Dial Int,2013,33(5):580-581.
[10]Traub WH,Geipei U,Leonhard B,et al.Antibiotic susceptibility testing(aga disk diffusion and aga dilution)of clinical isolates of Corynebacterium jeikeium[J].Chemotherapy,1998,44(4):230-237.
[11]Dinlevici EC,Yargic ZA,Bor O,et al.Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeiuminfection in a child with relapsing and refractory acute lymphoblastic leukemia[J].Pediatr Blood Cancer,2010,55(2):349-351.
[12]汪贵姣,杨柳,周明莉.重症患者留置尿管致泌尿系感染的相关因素与干预[J].中华医院感染学杂志,2011,21(17):3625-3626.
[2]邓法文.泌尿系感染病原菌分布及耐药性调查分析[J].中华医院感染学杂志,2012,22(17):3890-3892.
[3]Pitcher D,Johnson A,Allerberger F,et al.An investigation of nosocomial infection with Corynebacterium jeikeium in surgical patient using a ribosomal RNA gene probe[J].Eur J Clin Microbiol Infect Dis,1990,9(9):643-648.
[4]孙建平,何宏,张伟,等.临床表现隐匿的杰氏棒杆菌感染性心内膜炎一例[J].中华内科杂志,2016,55(4):325-326.
[5]霍颖鹏,黄朱亮.细菌16S核糖体RNA基因检测杰氏棒杆菌一株[J].中华诊断学电子杂志,2015,3(4):296-299.
[6]Cazanave C,Greenwood-Quaintance KE,Hanssen AD,et al.Corynebacterium prosthetic joint infection[J].J Clin Microbiol,2012,50(5):1518-1523.
[7]Bechara C,Gousseff M,Passeron A,et al.Corynebacterium jeikeium pacemaker infection associated with antineutrophil aytoplasmic antibodies:a single positive blood culture could be sufficient for diagnosis[J].J Med Microbiol,2011,60(Pt2):249-251.
[8]Ifantidou AM,Diamantidis MD,Tseliko G,et al.Corynebacterium jeikeium bacteremia in a hemodialyzed patient[J].Int J Infect Dis,2010,14(Suppl3):e265-268.
[9]Chao CT,Huang JW,Yen CJ.A rare and under-recognized pathogen in peritoneal dialysis peritonitis:Corynebacterium jeikeium[J].Perit Dial Int,2013,33(5):580-581.
[10]Traub WH,Geipei U,Leonhard B,et al.Antibiotic susceptibility testing(aga disk diffusion and aga dilution)of clinical isolates of Corynebacterium jeikeium[J].Chemotherapy,1998,44(4):230-237.
[11]Dinlevici EC,Yargic ZA,Bor O,et al.Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeiuminfection in a child with relapsing and refractory acute lymphoblastic leukemia[J].Pediatr Blood Cancer,2010,55(2):349-351.
[12]汪贵姣,杨柳,周明莉.重症患者留置尿管致泌尿系感染的相关因素与干预[J].中华医院感染学杂志,2011,21(17):3625-3626.