50例产单核细胞李斯特菌血流感染分析

Analysis of 50 cases of bloodstream infection with Listeria monocytogenes

目的分析产单核细胞李斯特菌的血流感染特点,为该病的诊治提供依据。方法回顾性分析2012年4月—2022年4月北京协和医院产单核细胞李斯特菌血流感染病例,统计患者年龄、性别、发病时间、基础疾病、症状、治疗及预后,分析抗感染治疗前后患者白细胞(white blood cells,WBC)、中性粒细胞、淋巴细胞和C反应蛋白(C-reactive protein,CRP)等指标变化。结果研究共纳入50例经血培养确诊的产单核细胞李斯特菌血流感染病例,患者年龄0~82(43.7±20.0)岁,其中60岁以上者占20.0%。患者发病时间春季占比最高(44.0%),其次为冬季(24.0%),夏秋季相对较少(14.0%~18.0%)。患者确诊中位时间为3 d(1~60 d),其中45例(90.0%)合并有基础疾病或妊娠状态。病原学确诊后,45例患者调整为以碳青霉烯类(48.9%)和青霉素类(44.4%)为主的目标性抗菌治疗,治疗后WBC、中性粒细胞、淋巴细胞、单核细胞和CRP水平均低于治疗前(P<0.05)。所有患者中,36例(72.0%)抗菌治疗方案符合《热病桑福德抗微生物治疗指南》,其中26例(72.2%)好转出院,2例死亡,1例转院,7例预后不良。结论自身免疫病、肿瘤、妊娠等人群为李斯特菌的易感人群,且病死率高。青霉素类是李斯特菌病有效的经验治疗首选药物,青霉素过敏者可选用甲氧苄胺嘧啶/磺胺甲噁唑或美罗培南治疗。

Objective To analyze the characteristics of bloodstream infection of Listeria monocytogenes and provide basis for the diagnosis and treatment of the disease.Methods We retrospectively analyzed the cases of Listeria monomyrhosi bloodstream infection in Peking Union Medical College Hospital(PUMCH)from April 2012 to April 2022.The age,sex,onset time,underlying disease,symptoms,diagnosis,treatment and prognosis of the patients were analyzed,as well as the changes of white blood cells(WBC),neutrophils,lymphocytes,and C-reactive protein(CRP)before and after anti-infection treatment.Results Fifty cases of Listeria monocytogenes bloodstream infection confirmed by blood culture were involved.The age of patients ranged from 0 to 82(43.7±20.0)years old,among whom 20.0%were over 60 years old.The onset time of patients was the highest in spring(44.0%),followed by winter(24.0%),and relatively fewer in summer and autumn(14.0%-18.0%).The median diagnosis time was 3 days(1-60 days).After the etiological diagnosis,45 patients(90.0%)had underlying diseases or pregnancy status,and 45 patients were adjusted to the target antibacterial treatment mainly with carbapenems(48.9%)and penicillins(44.4%).The level of WBC,neutrophils,lymphocytes,monocytes,and CRP after treatment were significantly lower than those pre-treatments(P<0.05).Among all patients,36 cases(72.0%)were treated according to the Antimicrobial Treatment Guidelines for Fever Sanford,of which 26 cases(72.2%)were discharged from the hospital,two cases died,one case was transferred to other hospitals,and 7 cases had a poor prognosis.Conclusions Autoimmune diseases,tumor diseases,pregnant patients are susceptible to Listeria monocytogenes infection.Penicillins are the first choice for effective empiric therapy.For the patients allergic to penicillins,trimethoprim/sulfamethoxazole or meropenem could be used.