偶发分枝杆菌致髋关节感染一例  

A rare case of hip infection due to Mycobacterium fortuitum

作　　者：张微[1] 张丽杰[2] 齐典文[3] 赵连春[4] 黄印启[2] 王鹏[2] 左惠芬[4] 孙永辉[5] 陈东科[6] ZHANG Wei ZHANG Lijie QI Dianwen ZHAO Lianchun HUANG Yinqi WANG Peng ZUO Huifen SUN Yonghui CHEN Dongke(Department of Clinnical Laboratory Medcine, The First Center Hospital of Baoding, Baoding, Hebei 071000, China Department of Clinnical Laboratory Medcine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China)

机构地区：[1]保定市第一中心医院检验科,河北保定071000 [2]河北医科大学第三医院检验科,河北石家庄050051 [3]河北以岭医院检验科,河北石家庄050091 [4]河北医科大学第三医院骨与软组织肿瘤科,河北石家庄050051 [5]河北以岭医院中医内科,河北石家庄050091 [6]北京医院检验科,北京000730

出　　处：《中国热带医学》2017年第1期104-106,共3页China Tropical Medicine

摘　　要：目的明确可能导致髋关节感染的病原菌,以便能够建立抗感染的有效治疗方案。方法对关节液培养中分离得到的菌株进行16SrRNA基因序列分析鉴定以及传统的抗酸染色、生化鉴定。结果16SrRNA基因序列分析显示分离株与偶发分枝杆菌有99%同源(GenBank编号:CP011269.1),生化分类及鉴别培养基结果也符合偶发分枝杆菌的特征,正式报告致病菌为偶发分枝杆菌。明确病原菌后,调整抗生素治疗方案为阿奇霉素静点+左氧氟沙星静点+复方新诺明口服。一个月后患者出院进行口服阿奇霉素+左氧氟沙星+复方新诺明+异烟肼的治疗,服药1年,随访1年半,病情未反复。结论16SrRNA基因测序鉴定偶发分枝杆菌快速而准确,显示了传统鉴定方法所不具备的一些优势。Objective To identify the causative pathogens of hip infection for the prompt, accurate and effectivetreatment. Methods The 16 S r RNA gene sequence of the strain isolated from synovial fluid culture was identified, and thetraditional acid-fast staining and biochemical identification were carried out. Results The gene（16S r RNA） sequencingresult showed that the causative agent belonged to Mycobacterium fortuitum（Gen Bank：CP011269.1, 99%）. Conventionalbiochemical and culture phenotypic characterization were also consistent with Mycobacterium fortuitum. Then we adjusted thetherapeutic regimen： azithromycin iv ＋ levofloxacin iv ＋ sulfamethoxazole tablets oral therapy. After a month of treatment, thepatient went home and continued to take orally the medicine for one year： azithromycin ＋ levofloxacin ＋ sulfamethoxazoletablets. We followed up for 1 year and a half, there was no recurrence of infection. Conclusion Sequencing of 16 S r RNA wasvery successful methods for idectifying nontuberculous Mycobacteria（NTM）, showing that traditional identification methods donot have some advantages.

关 键 词：非结核分枝杆菌 偶发分枝杆菌 快速生长型分枝杆菌 髋关节感染 

分 类 号：R529.2[医药卫生—内科学]