冈比亚农村地区一名 25 个月大的儿童在社区获得性耐多药泄殖腔肠杆菌败血症:病例报告

IF 1.1 Q4 INFECTIOUS DISEASES IDCases Pub Date : 2024-01-01 DOI:10.1016/j.idcr.2024.e02018
Baleng Mahama Wutor , Williams Oluwatosin Adefila , Keita Modou Lamin , Yusuf Abdulsalam O , Ilias Hossain , Minteh Molfa , Ousman Barjo , Rasheed Salaudeen , Isaac Osei , Grant Mackenzie
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引用次数: 0

摘要

泄殖腔肠杆菌是肠杆菌属中发病和死亡的主要原因。它主要引起院内感染,尤其是儿童、老人和患有基础疾病的人。不过,也有由泄殖腔杆菌引起的社区获得性菌血症病例的报道。由于泄殖腔杆菌越来越倾向于引起耐多药感染,因此其治疗尤其具有挑战性。一名 25 个月大的男童因持续高烧、呼吸困难和厌食一周后到冈比亚一家农村医院就诊。就诊前两天,他开始全身强直-阵挛发作。经检查,他发热、呼吸困难、面色苍白、心动过速。他的改良格拉斯哥昏迷量表评分为 9/15。检查结果显示,C反应蛋白升高、血红蛋白偏低、白细胞计数升高。脑脊液培养未发现任何生长。从入院当天的血液培养中分离出了泄殖腔杆菌。病原体对所有可用的抗生素都有抗药性。他接受了全血输注,最初使用阿莫西林-克拉维酸和庆大霉素进行经验性治疗。由于病情未见好转,前者改为头孢呋辛。患儿在入院九天后死亡。虽然泄殖腔杆菌主要以引起院内感染而闻名,但致命的社区获得性感染也时有发生。本病例报告表明,在资源匮乏的环境中,治疗对多种药物产生耐药性的泄殖腔杆菌十分困难,而且这种细菌很容易导致致命感染。
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Community-acquired multidrug-resistant Enterobacter cloacae sepsis in a 25-month-old child in rural Gambia: A case report

Enterobacter cloacae is the leading cause of morbidity and mortality in the genus Enterobacter. It mostly causes nosocomial infections, especially in children, the elderly and those with underlying diseases. However, cases of community-acquired bacteraemia caused by E. cloacae have been reported. The increasing inclination of E. cloacae to cause multidrug-resistant infections has made it particularly challenging to treat. A 25-month-old male child presented to a rural hospital in The Gambia with a one-week history of persistent high-grade fever, dyspnoea, and anorexia. Two days before presentation, he began to have generalized tonic-clonic seizures. On examination, he was found to be febrile, dyspnoeic, pale, and tachycardic. He had a modified Glasgow Coma Scale score of 9/15. Investigations revealed an elevated C-reactive protein, low haemoglobin, and elevated white blood cell count. Cerebrospinal fluid culture did not yield any growth. E. cloacae was isolated from a blood culture taken on the day of admission. The pathogen was resistant to all available antibiotics. He was transfused with whole blood and initially treated empirically with amoxicillin-clavulanic acid and gentamicin. The former was changed to cefuroxime because the child had not improved. The child died nine days after admission. Although E. cloacae is primarily known for causing nosocomial infections, fatal community-acquired infections also occur. This case report demonstrates the difficulty in treating multidrug-resistant E. cloacae in a low-resource setting and its propensity to cause fatal infections.

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IDCases
IDCases INFECTIOUS DISEASES-
CiteScore
2.60
自引率
6.70%
发文量
300
审稿时长
10 weeks
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