使用中心静脉导管治疗的实体瘤患者中的 Ralstonia insidiosa 菌血症

Hygiene Pub Date : 2024-04-17 DOI:10.3390/hygiene4020012
Lorenzo Ruggieri, A. Ridolfo, S. Rimoldi, M. S. Cona, Davide Dalu, Pietro Olivieri, Giuliano Rizzardini, S. Antinori, Anna Gambaro, S. Ferrario, C. Fasola, Maria Antista, Carmen Giusy Rea, N. La Verde
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摘要

Ralstonia spp.是一种低毒性环境革兰氏阴性菌,可导致免疫力低下患者发生严重的院内感染。我们报告了 2022 年 1 月至 3 月间发生在意大利米兰肿瘤科日间病房的一组 R. insidiosa 菌血症病例的特征。病例的定义是:在我们的日间病房就诊的癌症患者,其血液培养(因菌血症症状而进行)结果分离出了内生雷氏菌。为了寻找可能的感染源,我们进行了流行病学调查。七名成年患者通过管道输液(PAC)接受了治疗或缓解治疗。所有患者均在输液后 24 小时内出现症状(其中三人在输液过程中出现症状)。从所有患者的 PAC 抽取的血液中都分离出了 Ralstonia insidiosa。所有分离出的菌株均对碳青霉烯类、氟喹诺酮类和哌拉西林/他唑巴坦敏感,但对氨基糖苷类和头孢菌素类抗生素耐药。通过全身和/或锁定抗生素治疗,5 名患者的症状得到稳定缓解,血液培养结果呈阴性,但有 2 名患者再次发生菌血症。一项流行病学调查表明,消毒液的外源性污染可能是内生梭状芽孢杆菌感染的原因。虽然内生梭菌不被认为是一种烈性病原体,但临床医生、微生物学家和感染控制小组应该意识到它有可能引起院内血流感染的爆发,尤其是在使用中心静脉导管的免疫力低下的患者中。
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Ralstonia insidiosa Bacteremia in Patients with Solid Cancer Treated by Means of a Central Venous Catheter
Ralstonia spp. are low-virulent environmental Gram-negative bacteria that can cause serious nosocomial infections in immunocompromised patients. We report the characteristics of a cluster of R. insidiosa bacteremia cases occurring in our oncology day ward in Milan, Italy, between January and March 2022. A case was defined as a cancer patient attending our day ward and whose blood culture (performed because of bacteremia symptoms) led to the isolation of Ralstonia insidiosa. An epidemiological investigation was conducted in order to seek the possible source of infection. Seven adult patients received curative or palliative treatment via infusion through a Port-a-Cath (PAC). All developed symptoms within 24 h of the infusion (three during the infusion itself). Ralstonia insidiosa was isolated in the blood drawn from the PAC in all patients. All of the isolates were susceptible to carbapenems, fluoroquinolones, and piperacillin/tazobactam but resistant to aminoglycosides and cephalosporins. Systemic and/or lock antibiotic therapy led to stable symptom resolution and negative blood cultures in five patients, whereas bacteremia recurred in two patients. An epidemiological investigation suggested that extrinsic contamination of antiseptic solutions was the possible cause of the R. insidiosa infections. Although R. insidiosa is not considered a virulent pathogen, clinicians, microbiologists, and infection control teams should be aware about its potential to cause outbreaks of nosocomial bloodstream infections, especially in immunocompromised patients bearing central venous catheters.
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