艰难梭菌菌血症1例并文献复习  

Clostridium difficile bacteremia:one case report and literatures review

作　　者：杨靖[1] 魏宏莲[2] 尹凯歌[3] 强翠欣[1] 李志荣[1] 崔庆庆[1] 徐凯悦 李茹鑫 赵建宏[1,2] 

机构地区：[1]河北医科大学第二医院河北省临床检验中心,石家庄050000 [2]河北医科大学第二医院检验科 [3]河北医科大学第二医院消化内科

出　　处：《中国感染与化疗杂志》2016年第6期742-746,共5页Chinese Journal of Infection and Chemotherapy

基　　金：河北省科技厅基础条件平台建设项目(10966142D);河北省自然科学基金(H2013206450);河北医科大学第二医院科研基金(2h2201605)

摘　　要：目的了解艰难梭菌菌血症的临床特征。方法对1例艰难梭菌菌血症患者的临床表现、实验室检查结果、治疗及转归进行分析,并结合相关文献复习艰难梭菌菌血症的特征。结果该例39岁男性患者脑外伤后出现发热,血培养中检测出艰难梭菌,其毒素A、B及ニ元毒素基因均阳性。使用头孢曲松-他唑巴坦和去甲万古霉素联合抗感染治疗14d后,患者康复出院。通过文献复习发现艰难梭菌菌血症患者大多数有慢性肝炎、肝硬化等消化道基础疾病,主要症状为发热、腹痛、血便、恶心呕吐等。使用过甲硝唑或万古霉素治疗的患者死亡2例(2/13)未使用的患者死亡4例(4/6)。结论艰难梭菌菌血症患者大多数都有慢性基础疾病、消化道疾病或有手术及外伤史。早期应用万古霉素和甲硝唑治疗,其预后相对较好。Objective To investigate the clinical characteristics of Clostridium difficile bacteremia.Methods The clinical manifestations,laboratory test results,treatment and outcome of the patient with C.difficile bacteremia were analyzed.Related literatures about C.difficile bacteremia were also reviewed.Results The patient was a 39 year-old male.He had a fever after craniocerebral trauma.C.difficile（tcdA＋,tcdB＋,cdtA＋ and cdtB＋） was identified from blood culture.The patient recovered after treatment with ceftriaxone-tazobactam and norvancomycin for 14 days.Literature reports showed that majority of patients with C.difficile bacteremia had gastrointestinal diseases,such as chronic hepatitis,cirrhosis.The main symptoms included fever,abdominal pain,bloody stools,nausea and vomiting.Two（2/13） of the patients treated with metronidazole or vancomycin four of the patients without metronidazole or vancomycin treatment（4/6） died.Conclusions Most patients with C.difficile bacteremia have chronic underlying diseases,gastrointestinal diseases or a history of trauma or surgery.Early use of vancomycin and metronidazole may improve the prognosis of patients.

关 键 词：艰难梭菌 菌血症 二元毒素 万古霉素 甲硝唑 

分 类 号：R515.3[医药卫生—内科学]