艾滋病合并雷根斯堡约克菌败血症1例并文献复习

AIDS complicated with Yokenella regensburgei septicemia: one case report and literature review

目的了解罕见病原菌雷根斯堡约克菌感染的可能危险因素及其临床特征。方法对1例雷根斯堡约克菌败血症患者的临床表现、实验室检查结果、治疗及预后分析,并以“Yokenella regensburgei”为关键词,检索PubMed数据库关于雷根斯堡约克菌感染的所有文献,分析发生该病原菌感染的易感因素、感染部位、临床特征、治疗及预后。结果该例为38岁男性患者,有静脉药瘾史,既往确诊人类免疫缺陷病毒(HIV)感染,以反复发热为主要临床表现,体温波动于38.5℃左右,单独取4份血样送检培养均提示“雷根斯堡约克菌”生长,选取头孢西丁抗感染治疗,体温恢复正常,复查血培养未见该菌再生长。通过文献复习结合该例患者,共8例患者,其中男6例,女2例,年龄5~82岁;7例均存在基础疾病或者药瘾、酗酒等情况;感染部位5例为血流感染,2例为关节处软组织感染,1例为骨髓感染;选用抗菌药物分别有阿米卡星、环丙沙星、头孢曲松、亚胺培南-西司他丁、头孢西丁;5例治愈,1例死亡,2例预后不详。结论雷根斯堡约克菌易感染存在免疫功能低下患者,其致病性不强,对大多数抗菌药物敏感,感染后预后较好。

Objective To understand the possible risk factors and clinical characteristics of rare pathogenic bacterium Yokenella regensburgei infection.Methods The clinical manifestations,laboratory findings,treatment and prognosis were reported in one case of Yokenella regensburgei septicemia.Using“Yokenella regensburgei”as search term to retrieve relevant citations from PubMed database.The predisposing factors,site of infection,clinical characteristics,treatment,and prognosis were reviewed.Results A 38-year-old male patient with a history of intravenous drug abuse was diagnosed with human immunodeficiency virus(HIV)infection.His main clinical manifestation was recurrent fever.The temperature fluctuated at about 38.5℃.Culture of 4 blood samples suggested growth of Yokenella regensburgei.Cefoxitin was used to treat the infection.The temperature returned to normal and no pathogenic bacteria were found in blood culture.Literature search identified 7 similar cases.The 8 cases(including this one)were reported in 6 males and 2 females,at age from 5 to 82 years.All the 7 cases in literature report had underlying disease,drug abuse or alcohol abuse.Bloodstream infection was reported in 5 cases,joint soft tissue infection in 2 cases,and bone marrow infection in 1 case.Amikacin,ciprofloxacin,ceftriaxone,imipenem-cilastatin and cefoxitin were used in these cases.Cure was reported in 5 cases,death in one case,and unknown outcome in 2 cases.Conclusions Immunocompromised individuals are susceptible to Yokenella regensburgei infection.Yokenella regensburgei is not highly pathogenic.It is susceptible to most antibiotics and associated with good treatment outcome.