急性白血病患者尖端赛多孢子菌与细菌多重感染的实验诊断及治疗  

Scedosporium apiospermum in Patient with Acute Leukemia and Bacterial Multiple Infections:Experimental Diagnosis and Treatment

作　　者：尹秀云[1] 陈建魁[1] 俞志勇[1] 宋世平[1] 胡亮钉[1] 左向华[1] 赵辉[1] 于农[1] 金欣[1] 

机构地区：[1]军事医学科学院附属307医院检验科,北京100071

出　　处：《中华医院感染学杂志》2010年第23期3833-3835,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨尖端赛多孢子菌及细菌引起急性髓性白血病患者多重感染的诊断方法和治疗措施。方法连续采集患者左侧腹股沟分泌物或坏死组织行真菌和细菌培养,同时对阴茎冠状沟和包皮做病原菌检查;采用法国生物梅里埃公司VITEK-2全自动微生物分析仪对细菌进行鉴定和药敏试验;根据真菌培养的菌落特点和镜下形态鉴定致病真菌,采用MIC方法进行真菌体外药敏试验。结果抗真菌治疗前患者左侧腹股沟分泌物连续4次行真菌培养,均检测出尖端赛多孢子菌,体外药敏试验显示对伏立康唑有较低的MIC值,而对两性霉素B高度耐药;左侧腹股沟分泌物细菌培养结果分别为产ESBLs肺炎克雷伯菌和产ESBLs大肠埃希菌;阴茎冠状沟和阴茎包皮处细菌培养结果均为产ESBLs肺炎克雷伯菌和耐氨基糖苷类高水平粪肠球菌;产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星等抗菌药物敏感;耐氨基糖苷类高水平粪肠球菌敏感抗菌药物有:万古霉素、替考拉宁、亚胺培南。结论尖端赛多孢子菌的感染少见,且难治疗,极易感染免疫低下的患者合并细菌引起多重感染;及时进行分离、培养、鉴定和药物敏感性试验,及早进行病原学诊断,正确选用抗菌药物是治疗成功与否的关键。OBJECTIVE To study the experimental diagnosis and treatment of multiple infections with Scedosporium apiospermum and bacteria in patient with leukemia.METHODS The successive skin secretions and necrotic tissue were inoculated to mediums to culture medical fungi and bacteria.The bacteria were identified and the drug sensitivity were tested using VITEK 2 automatic microorganisms analyzer.RESULTS The S.apiospermum were isolated in the four samples of the successive skin secretions.The S.apiospermum was sensitive to the Voriconazole and resistant to the amphotericin B.The bacteria isolated in the skin secretions were Escherichia coli（ESBL＋）,Klebsiella pneumoniae（ESBL＋）and Enterococcus faecalis.The sensitivity of E.coli（ESBL＋） and K.pneumoniae（ESBL＋）to all the antibiotics such as imipenem,piperacillin/tazobactam,amikacin,and so on tested were sensitive.The results of the sensitivity tests showed that E.faecalis（HLAR.E） were sensitive to vancomycin,teicoplanin and imipenem.CONCLUSION The S.apiospermum is a rare pathogen in the clinical infections which is hard to cure.In cases of hypoimmunity,the multiple infections could be occured.Therefore,infection of S.apiospermum should be timely diagnosed and treated,so as to cure the disease rapidly and effciently.

关 键 词：尖端赛多孢子菌 大肠埃希菌 肺炎克雷伯菌 粪肠球菌 白血病 多重感染 

分 类 号：R378[医药卫生—病原生物学]