汕头地区4例散发创伤弧菌感染的实验室诊断

Laboratory analysis on 4 cases of sporadic Vibrio vulnificus infection in Shantou City

目的了解汕头市某院创伤弧菌(VV)感染患者的病原微生物学特征及药物敏感性。方法回顾性分析汕头市某院2013年6月—2014年6月收治的4例VV感染患者,采集患者血标本进行培养,采集患者疱液或棉拭子采集伤口分泌物接种于血平板、麦康凯平板及TCBS平板,对分离的菌株进行鉴定和药敏试验。结果 4例VV感染患者,其中死亡3例,治愈1例;分别因进食腌蟹、蒸扇贝或外伤后接触海产品,而引起原发性败血症及下肢感染。患者A、B疱液,患者C伤口分泌物,患者D血培养均分离出氧化酶阳性、TCBS平板上生长呈绿色的革兰阴性菌,均鉴定为VV。VV对头孢唑林耐药或中介,对头孢替坦均为中介,1株VV对头孢吡肟耐药。结论 4例VV感染患者病死率高(3/4),疱液或伤口分泌物培养阳性率较血培养高;及时就诊、尽早开始抗菌药物治疗及积极清创有助于治疗该病。

Objective To analyze characteristics of pathogenic microbiology and antimicrobial susceptibility of Vibrio vulnificus（V.vulnificus）causing infection in patients at a hospital in Shantou City.Methods Four patients with V.vulnificus infection admitted to a hospital between June 2013 and June 2014 were analyzed retrospectively,blood specimens of patients were collected for culture,blister fluid and wound secretion were taken and inoculated on blood agar plates,MacConkey agar plates,and thiosulfate citrate bile salts sucrose（TCBS）plates,isolated strains were identified and performed antimicrobial susceptibility testing.Results Among 4 patients with V.vulnificus infection,3 died,1 was cured;patients developed primary septicemia and lower extremity infection because of eating pickled crab,steamed scallop,or contacting with seafood products after trauma.Blister fluid from patients A and B,wound secretion from patient C,and blood from patient D were all isolated oxidase-positive gramnegative bacteria which produced green colonies on TCBS plate,these strains were identified as V.vulnificus,which were resistant or intermediate to cefazolin,intermediate to cefotetan,and 1 strain was resistant to cefepime.Conclusion Four patients infected with V.vulnificus have high mortality rate（3/4）,positive rates of blister fluid and wound secretion are higher than blood;timely medical consultation,early antimicrobial therapy,and active debridement will help to cure the disease.