单核细胞增生李斯特菌感染患者的临床特征分析

Analysis of clinical characteristics of patients with Listeria monocytogenes infection

目的分析单核细胞增生李斯特菌(Listeria monocytogenes,LM)感染患者的病原学特点及临床特征,找到影响预后的因素,为临床早期诊治提供依据。方法通过电子病例系统查询北京、宁夏、苏州和广州等地区5家医院2011—2023年间临床分离的无菌体液和组织以及宫颈分泌物和耳道分泌物鉴定为LM患者的病例信息,并收集其菌株,回顾性分析LM病原学特点及感染者临床特征,探讨导致患者死亡的危险因素。结果共纳入68例患者病例,LM的感染以50岁以上的中老年患者居多(51.47%);感染部位以血流感染为主(51.85%),主要临床表现为发热;其次是颅内感染(24.0%),主要临床表现为发热、头晕、头痛、意识模糊和感染性休克等,整体死亡率达到23.53%。存活组C反应蛋白(CRP)[58.77(5.1~183)mg/L vs 89.08(12.4~272.7)mg/L,P=0.027]和降钙素原(PCT)[2.88(0.04~55.50)ng/L vs 12.35(0.19~38.56)ng/L,P=0.020]均明显低于死亡组。早期抗生素的选择对患者的生存率具有显著影响(P=0.008)。结论LM感染死亡率较高,年龄分布以中老年患者为主,感染部位以血流感染和颅内感染为主,不同的感染部位具有不同的临床表现,以发热最为常见。CRP和PCT的升高程度与患者的生存率呈负相关。青霉素、氨苄西林、复方磺胺甲恶唑、红霉素、美罗培南对LM都具有很高的体外抑菌,但复方磺胺甲恶唑不适用于孕妇和新生儿,尽早使用有效灭活LM的抗生素,对提高患者生存率极其重要。

Objective To analyze the pathogenic characteristics and clinical characteristics of patients infected by(Listeria monocytogenes,LM),find the factors that affect the prognosis,and provide a basis for early clinical diagnosis and treatment.Methods The case information of patients identified as LM from clinical isolation of sterile body fluids and tissues,cervical secretions and ear canal secretions from 5 hospitals in Beijing,Ningxia,Suzhou and Guangzhou from 2011 to 2023 was queried through an electronic medical records system.Their strains were collected,retrospectively analyzed for pathogenic and clinical characteristics,and explored as risk factors leading to patient death.Results A total of 62 patient cases that infected LM were mainly middle-aged and elderly patients who were over the age of 50 years old,accounting for 51.47%.The infection site was mainly a blood flow infection(51.85%);the main clinical manifestation was fever,followed by intracranial infection(24.0%),manifested as fever,dizziness,headache,confusion,septic shock,etc.The overall mortality rate reached 23.53%.Survival group C-reactive protein(CRP)[58.77(5.1~183)mg/L vs.89.08(12.4~272.7)mg/L,P=0.027]and procalcitonin(PCT)[2.88(0.04~55.50)ng/L vs 12.35(0.19~38.56)ng/L,P=0.020]were significantly lower than the death group.The choice of early antibiotic had a significant effect on the survival rate of patients(P=0.008).Conclusion The mortality rate from LM infection was higher.The age distribution was mainly middle-aged and elderly patients.The most common infection sites were blood flow infection and intracranial infection.Different infection sites had different clinical manifestations;fever was the most common manifestation.There was a negative correlation between the degree of increase in CRP and PCT and the survival rate of patients.Penicillin,ampicillin,trimethoprim/sulfamethoxazole,erythromycin,and meropenem all had high in vitro antibacterial effects on LM,but trimethoprim/sulfamethoxazole was not suitable for pregnant women and neonates.The early use of antibiotics that effectively inactivated LM was extremely important to improve the survival rate of patients.