急性白血病患者裂褶菌感染的实验室诊断研究  

Laboratorial diagnosis of multiple infections caused by Schizophyllum commune in an acute leukemia patient

作　　者：尹秀云[1] 梁钰英 于农[1] 扈江伟 江岷 曾利军[1] 李一鹤[1] 蒋虔[1] 徐建民[1] 杨哲[1] 陈建魁[1] 陈水平[1] 

机构地区：[1]军事医学科学院附属医院检验科,北京100071 [2]全军造血干细胞研究所,北京100071

出　　处：《中华医院感染学杂志》2015年第24期5593-5595,共3页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2013ZX10004203);国家重大科学仪器设备开发专项基金资助项目(2012YQ18011708);解放军307医院创新科研基金资助项目(ZH-2014-09)

摘　　要：目的探讨裂褶菌及细菌引起急性髓性白血病造血干细胞移植患者多重感染的试验诊断和治疗方法,为临床诊断该菌感染及经验治疗提供科学依据。方法 2014年12月连续采集两次1例急性髓性白血病行造血肝细胞移植患者副鼻窦分泌物和副鼻窦清创术后坏死组织,进行真菌和细菌培养;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;采用肉汤稀释法(CLSI M38-A2)进行真菌体外药敏试验,数据采用SPSS 17.0软件进行统计分析。结果该例患者副鼻窦清创术后组织块真菌培养结果为裂褶菌,其对伏立康唑有较低的MIC值;连续两次副鼻窦分泌物和术中留取的组织块细菌培养结果均为大肠埃希菌和嗜麦芽寡养单胞菌;产ESBLs大肠埃希菌对亚胺培南、美罗培南、阿米卡星、头孢他啶等均为敏感,嗜麦芽寡养单胞菌敏感抗菌药物只有磺胺甲噁唑/甲氧苄啶。结论裂褶菌的感染少见,且难诊断,极易感染免疫低下的患者,及早进行病原学诊断,正确选用抗菌药物,是抗感染治疗成功与否的关键。OBJECTIVE To investigate the diagnosis and treatment of multiple infections caused by Schizophyllum commune and bacteria in an acute leukemia patient after hematopoietic stem cell transplantation so as to provide reference for clinical diagnosis of this infection and emprical treatment. METHODS The specimens sampled from the nasal secretions and paranasal sinus tissues were collected and inoculated on agar plates for fungal and bacterial culture. The bacterial identifications and the drug sensitivity test were performed using VITEK-2 automatic micro- organism analyzer. The in vitro drug sensitivity test of fungi was performed with broth dilution method according to the CLSI-M38-A2 scheme. The SPSS 17.0 software was used for statistical analysis. RESULTS The resluts showed S. commune was＇ isolated from the paranasal sinus tissue and it was documented to be sensitive to voriconazole as the MIC was low. Escherichia coli （ESBL＋）and Stenotrophomonas maltophili were confirmed in the nasal secretions and paranasal sinus tissues by two consecutive cultures. E. coli（ESBL＋）was sensitive to imipenera, meropenem, amikacin, and ceftazidime. S. maltophili was only sensitive tO sulfamethoxazole. CONCLUSION Infection caused by S. commune is rare and difficult to diagnose. In immunosuppressive cases,the multiple infec; tions could occur. Therefore, early diagnosis of S. Commune infection and correct selection of antibacterial agents are very important for anti-infection treatment of patients after hemotopoietic stem cell transplantation.

关 键 词：白血病 造血干细胞移植 裂褶菌 诊断研究 

分 类 号：R446[医药卫生—诊断学]