小肠穿孔致明串珠菌血症一例并文献复习

Report of a case of Leuconostoc lactis bacteremia following intestinal perforation with literature review

报道1例小肠穿孔所致明串珠菌血症患者的诊治过程,以“明串珠菌”“感染”“leuconostoc lactis”和“bacteraemia”为关键词检索万方数据库、中国知网、PubMed、Embase数据库等检索截至2020年9月所有相关文献并复习。本例患者入院第4天血培养结果为明串珠菌,痰培养结果为鲍曼不动杆菌,经哌拉西林钠他唑巴坦联合替加环素治疗感染控制。文献共纳入32例患者,其中婴幼儿13例(39.4%)为主要易感人群,导管相关血流感染17例(51.5%)为主要感染途径,有1例健康成年男性通过消化道穿孔入血。以青霉素类抗菌药物为基础治疗的20例(60.6%)患者治疗成功18例,有效率90.0%。提示明串珠菌感染容易发生在婴幼儿群体,但是健康的成年人仍可在社区获得性感染明串珠菌。大多数β-内酰类抗菌药物对明串珠菌敏感,但是一部分会表现出耐药,因此建议依据药敏选择抗菌药物。

A 24-year female with abdominal pain and fever for 4 days was admitted.The blood culture showed Leuconostoc growth,and sputum culture showed positive Acinetobacterbaumannii.The diagnosis Leuconostoclactis bacteremia following small intestinal perforation was confirmed;surgical treatment was performed and the infection was controlled by piperacillin sodium and tazobactam combined with tegacycline.Wanfang database,CNKI,PubMed and Embase database up to September 2020 were searched with the keywords of"Leuconostoc lactis""infection""bacteraemia"for relevant literature.A total of 32 cases were reported in the literature,of whom 13(39.4%)were infants,17(51.5%)had catheter-related bloodstream infection,and one healthy adult male had bacteremia through gastrointestinal perforation.In 20 patients treated with penicillins-based antibiotics,18 were cured with an effective rate of 90.0%.The results suggest that Leuconostoc infection is likely to occur in the infants,but adults can still get community-acquired Leuconostoc infection.Mostβ-lactams are susceptible to Leuconostoc,but some exhibit resistance,so it is recommended to select antimicrobial agents based on drug susceptibility.