脑出血患者血培养分离出胶红酵母菌的临床观察

Clinical observation of rhodotorula mucilaginosa isolated from blood culture of patients with cerebral hemorrhage

目的探讨颈内静脉穿刺置管术引起的胶红酵母菌血流感染的微生物学诊断特征并为临床治疗提供依据。方法回顾性分析2018年1月14日兰州市第一人民医院重症医学科收治的1例脑出血后并发感染的患者,分析患者血液和导管微生物学培养、鉴定、药物敏感试验的结果及临床采取的相应治疗措施。结果患者中心静脉血培养92 h后需氧瓶和厌氧瓶均报阳性,导管培养48 h后血平板呈现乳白色菌落,均经涂片革兰氏染色镜检见到卵圆形或椭圆形真菌孢子及菌丝,经分离、培养、鉴定,确定为胶红酵母菌。体外药敏实验显示对氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑类抗真菌药物均敏感。临床医生考虑可能为导管相关性血流感染,暂未给予抗真菌药物治疗,而是拔出静脉导管,复查血培养结果转为阴性。结论红酵母菌属为一类新型机会致病菌,红酵母真菌血症多来源于医源性因素,临床医生需综合考虑是否对其采取抗真菌治疗。

Objective To explore the diagnostic features of microbiology of rhodotorula mucilaginosa bloodstream infection caused by internal jugular vein puncture and to provide basis for the clinical treatment.MethodsA case of cerebral hemorrhage complicated with infection admitted to the Intensive Care Department of The First People′s Hospital of Lanzhou City,on January 14,2018 was retrospectively analyzed.The results of microbiology culture,identification,drug sensitivity test of blood and catheter and corresponding clinical treatment measures were analyzed.ResultsBoth of aerobic and anaerobic blood culture of the central vein for the patient were positive after 92 h,in addition,the culture of catheter showed milky white colonies on blood agar plate after 48 h,and the microscopic examination of the Gram staining smear showed oval or elliptical fungal spores and hyphae,which were isolated,cultured and identified as rhodotorula mucilaginosa.The drug sensitivity test showed that it was sensitive to antifungal agents in vitro,such as flucytosine,amphotericin B,fluconazole,itraconazole and voriconazole.The clinician considered that it maybe catheter-related blood stream infection,and just pulled out the venous catheter instead of giving antifungal therapy,then reexamination of blood culture presented negative.ConclusionsRhodotorula mucilaginosa is an emerging opportunistic pathogen,which is mostly derived from iatrogenic factors.Clinicians need to consider whether to take antifungal treatment for it.