严重免疫力低下患者的伊丽莎白金丝菌血流感染:持续、复发且死亡率高。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-10-25 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae161
Mark Fahmy, Adam Stewart, Siok-Keen Tey, Krispin Hajkowicz
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引用次数: 0

摘要

目的:伊丽莎白金丝菌是引起血流感染的罕见病原体,是免疫力低下或易感宿主的真正机会性和多重耐药病原体。尽管如此,目前仍缺乏有关该病原体感染的最佳管理策略的数据,该病原体感染会导致严重的死亡率和发病率。我们描述了该系列病例中患者的特征、管理和结果:通过数据库查询,确定了布里斯班皇家妇女医院所有伊丽莎白金格氏菌血液培养呈阳性的住院患者。收集的临床信息包括病史、感染源、控制感染源的尝试和结果。此外,还收集了包括菌血症持续时间和抗菌药敏感性测试在内的实验室数据:结果:所有患者的先天性免疫和适应性免疫均存在严重缺陷。结果:所有患者都存在严重的先天性和适应性免疫缺陷,均已及时开始针对性治疗,并采取了适当的病源识别和控制措施。尽管如此,治疗效果普遍不佳。其中一个病例出现了以前未曾发现的复发性感染,需要长期服用抗菌药物才能控制病情。一个病例因感染而死亡,一个病例虽然治愈,但不久后因免疫抑制并发症而死亡:结论:由于有效疗法有限、耐药性的产生以及宿主免疫功能极度低下,治疗这些病菌具有挑战性。前期使用多种剂量最佳的抗菌药物、尝试源头控制和尝试恢复宿主免疫功能似乎都是取得良好疗效的关键。
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Elizabethkingia bloodstream infections in severely immunocompromised patients: persistent, relapsing and associated with high mortality.

Objectives: Elizabethkingia species are uncommon causes of bloodstream infections, representing a true opportunistic and multi-drug-resistant pathogen to immunocompromised or vulnerable hosts. Despite this, data are lacking regarding optimal management strategy for infections with this organism, which is associated with significant mortality and morbidity. We describe patient characteristics, management and outcomes in this case series.

Patients and methods: All inpatients at the Royal Brisbane and Women's Hospital with a positive blood culture for Elizabethkingia spp. were identified by database query. Clinical information including medical history, source of infection, attempts at source control and outcome were collected. Laboratory data including duration of bacteraemia and antimicrobial susceptibility testing were also collected.

Results: All patients had severe defects of innate and adaptive immunity. Targeted therapy was started promptly and efforts at source identification and control were appropriately pursued. Despite this, outcomes were generally poor. A previously unrecognized presentation of relapsing infection was described in one case, requiring long-term suppressive antimicrobials to control. One case died as a result of infection and one case was cured, but died soon after due to complications of immunosuppression.

Conclusions: Treatment of these organisms is challenging due to limited effective therapy, development of on treatment resistance and profound host immunocompromise. Up-front use of multiple, optimally dosed antimicrobials, attempting source control and attempting to restore host immune function all appear to be key to achieving good outcomes.

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来源期刊
CiteScore
5.30
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审稿时长
16 weeks
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