马红球菌所致复杂性软组织感染1例报告并文献复习

Complicated soft tissue infection caused by Rhodococcus equine:a case report and systemic literature review

目的探讨马红球菌所致复杂性软组织感染的诊断和治疗,并复习文献。方法回顾性分析延边大学附属医院重症医学科收治的1例因马红球菌所致复杂性深部软组织感染成年患者的临床资料。结果患者男性,59岁,既往体健,不明原因出现右侧腰部疼痛,后蔓延至右下肢,出现红肿、发热及右下肢活动障碍,表现为典型的化脓性感染。入院后短时间内进展为脓毒症、多器官功能障碍综合征,血培养及脓液培养生长马红球菌。经积极抗休克、抗感染、连续性肾脏替代治疗(CRRT)、以及2次清创手术治疗,20 d后患者痊愈出院。经文献复习证实马红球菌为临床少见的机会性致病菌,多导致免疫功能低下人群感染,临床罕见免疫正常人群患马红球菌重度感染病例。结论马红球菌可致免疫功能正常人群软组织感染,在诊疗过程中遇到化脓性病例,应警惕马红球菌感染的可能。在治疗上除合理使用抗菌药物外,局部病变的处理更为关键,同时需警惕耐药菌的出现。

Objective To explore the diagnosis and treatment of complicated soft tissue infection caused by Rhodococcus equine and review the literature.Methods Clinical data of an adult patient with complicated deep soft tissue infection caused by Rhodococcus equine were retrospectively analyzed in the department of critical care medicine of Yanbian University Hospital.Results The patient was a 59-year-old man who was healthy in the past.He developed unidentified pain of the right lower back and spread to the right lower extremity,aggravated with redness,swelling,fever and movement disorder of the right lower extremity,showing typical acute suppurative infection.Shortly after admission,he developed sepsis,multiple organ dysfunction syndrome,and Rhodococcus equine was identified in the blood and abscess culture.The patient received effective therapies,including targeted antibiotics,vasopressors,continuous renal replacement therapy(CRRT)and with two debridement operations,the patient was cured and discharged after 20 days.Through the reviewing of literatures,Rhodococcus equine is a conditional pathogenic bacterium which mostly leads to infection of immunocompromised patients,however,severe Rhodococcus equine infection in normal immune population is rare in clinical practice.Conclusions Rhodococcus equine can cause soft tissue infection in people with normal immune function.In clinical practice,we should consider the possibility of Rhodococcus equine induced suppurative infection.In addition to the rational use of antibiotics,the local debridement operation is more critical.Furthermore,we also should be alert to the emergence of drug-resistant bacteria strain of Rhodococcus equine.