冢村菌致导管相关血流感染1例并文献复习

Catheter-related bloodstream infection caused by Tsukamurella species:one case report and literature review

目的探讨冢村菌所致导管相关血流感染的临床表现和诊治,提高临床对该病的认识。方法回顾1例冢村菌引起的导管相关血流感染患者的临床资料,并以英文检索词“Tsukamurella”检索PubMed数据库,以中文检索词“冢村菌”或“冢村氏菌”检索中国知网、万方和维普数据库,获取国内外报道的冢村菌致导管相关血流感染的病例资料并进行总结分析。结果患者系37岁男性,基础疾病为短肠综合征、脾功能亢进、腹腔硬纤维瘤,长期留置有经外周静脉穿刺中心静脉导管,主要起病症状为发热,经血培养和导管尖端培养明确诊断为冢村菌致导管相关血流感染,先后经头孢哌酮-舒巴坦、亚胺培南-西司他丁抗感染后治愈。文献检索获取到56个病例,多为免疫功能受损患者。多数病例采用化学分类和/或分子技术鉴定方法进行了病原菌鉴定。在治疗过程中,大多患者的血管内导管被拔除。除1例患者结局未知,55例患者中有54例生存,1例死亡,但不能明确其是否死于冢村菌感染。结论冢村菌是一种机会致病菌,引起的临床感染相当少见,其鉴定有赖于质谱技术和基因测序。除了选用合适的抗生素,拔除血管内导管对控制感染往往必不可少。

Objective To investigate the clinical manifestations,diagnosis and treatment of catheter-related bloodstream infection caused by Tsukamurella species,and improve clinicians’awareness of this disease.Methods Data were retrospectively collected from a patient who was diagnosed with catheter-related bloodstream infection caused by Tsukamurella species.The databases of PubMed,CNKI,Wanfang and VIP were searched,using the term“Tsukamurella”,to identify the reported cases of catheter-related bloodstream infection caused by Tsukamurella species.The relevant data were extracted for further analysis.Results Our case was a 37-year-old male with underlying diseases including short bowel syndrome,hypersplenism,and intra-abdominal desmoid tumor,who had a long-term indwelling peripherally inserted central catheter.He presented with fever,and was diagnosed with catheter-related bloodstream infection caused by Tsukamurella species based on cultures of peripheral blood sample and catheter tip.He eventually recovered after antimicrobial treatment with cefoperazone-sulbactam followed by imipenem-cilastatin.We identified 56 cases in the literature search,of which most patients were immunocompromised.Chemotaxonomic and/or molecular methods were utilized for pathogen identification in most cases.Intravascular catheters were removed for treatment in most of the patients.Overall,one patient died,54 patients survived,and the outcome of one patient was unknown.It was unclear whether the only death was attributable to Tsukamurella species infection.Conclusions Tsukamurella species are opportunistic pathogens,which are rarely seen in clinical practice.The identification of these bacteria relies on mass spectrometry and gene sequencing.In addition to appropriate antibiotic treatment,removal of intravascular catheters is essential to infection control.