多器官功能衰竭患者检出栖稻假单胞菌1例

Isolation Pseudomonas oryzihabitans from a patient with multiple organ failure

栖稻假单胞菌(Pseudomonas oryzihabitans,P.oryzihabitans)作为条件致病菌和院内感染菌,多见于免疫力低下合并基础疾病患者,其抗感染预后良好,甚少出现多器官功能衰竭病例。本例患者无明显诱因出现双下肢水肿半月余,后全身乏力、气短、尿少3d,继而出现多器官功能衰竭。患者的血培养中检出1株革兰氏阴性杆菌,经生化鉴定、全自动快速微生物质谱检测(MALDI-TOF MS)和16SrRNA测序,鉴定为P.oryzihabitans;运用Mega 7.0软件构建系统发育树,发现其与耐冷假单胞菌(Pseudomonas psychrotolerans,P.psychrotolerans)亲缘关系十分密切;采用纸片扩散法(Kirby-Bauer method,K-B method)进行药物敏感试验(antimicrobial susceptibility test,AST),显示该菌对头孢他啶、庆大霉素、亚胺培南、左氧氟沙星等敏感,对氨曲南、氨苄西林、头孢唑啉等耐药。采用亚胺培南西司他丁联合莫西沙星对患者进行抗感染治疗,但因患者家属要求出院,无法追踪后续治疗结果。本例报告提示,临床微生物工作者应关注栖稻假单胞菌病例报道和相关研究,以获取更多资料为该病的临床诊治提供依据。

Pseudomonas oryzihabitans(P.oryzihabitans),as an opportunistic pathogen associated with nosocomial infection.It is commonly seen in immunocompromised patients who achieved favorable prognosis after anti-infection treatment.Cases of multiple organ failure are rare.The patient in this case had a bilateral lower limb edema for two weeks without obvious inducement,followed by fatigue,shortness of breath and oliguria for 3 days,and multiple organ failure.Strain TS383 of gram-negative bacilli was isolated from patient blood culture.It was identified as P.oryzihabitans by biochemical identification,MALDITOF and 16 SrRNA sequencing.A phylogenetic tree was constructed with Mega 7.0 software and TS383 was found to be related to Pseudomonas psychrotolerans.In vitro antimicrobial susceptibility test(AST)was conducted by Kirby-Bauer(K-B),which showed that the strain TS383 was sensitive to ceftazidine,gentamicin,imipenem and levofloxacin,and resistant to ampicillin,cefazoline and other drugs.The patient was treated with imipenem cilastatin combined with moxifloxacin but was unable to tracked with follow-up results as his family requested discharge.This case indicates that the microbiological laboratory personnel need to pay more attention to P.oryzihabitans infections.