24例单核细胞增生李斯特菌败血症患者临床特征分析  被引量:2

Clinical characteristics of 24 patients with Listeria monocytogenes sepsis

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作  者:张仁雯 刘永哲 于晓敏[1] 刘骏 谷丽[1] Zhang Renwen;Liu Yongzhe;Yu Xiaomin;Liu Jun;Gu Li(Department of Infectious Diseases and Clinical Microbiology,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,100020,China)

机构地区:[1]首都医科大学附属北京朝阳医院、北京市呼吸疾病研究所感染和临床微生物科,100020

出  处:《传染病信息》2023年第4期346-350,共5页Infectious Disease Information

摘  要:目的分析总结12例非妊娠期单核细胞增生李斯特菌(Listeria monocytogenes,LM)败血症患者和12例妊娠期LM败血症患者的临床特征,为临床诊治提供依据。方法回顾性分析2010年10月—2021年6月在首都医科大学附属北京朝阳医院住院治疗并经血培养确诊的12例非妊娠期LM败血症患者(非妊娠组)和12例妊娠期LM败血症患者(妊娠组)的临床特征。结果临床表现包括发热、胃肠道症状等,妊娠组4例可见胎心异常(33.3%),非妊娠组患者5例合并中枢神经系统感染(41.7%)。妊娠组WBC[(15.44±6.59)×10^(9)/L vs.(7.58±3.89)×10^(9)/L,P=0.002]、中性粒细胞计数[(11.94±6.17)×10^(9)/L vs.(6.45±3.65)×10^(9)/L,P=0.015]及淋巴细胞计数[(2.32±1.39)×10^(9)/L vs.(0.66±0.55)×109/L,P=0.001]均明显高于非妊娠组患者;C-反应蛋白则低于非妊娠组患者[13.35(35.28)mg/L vs.42.5(161.23)mg/L,P=0.011]。所有患者经验性初始治疗均以头孢菌素为主,其中妊娠组7例,非妊娠组8例。血培养阳性后调整治疗方案,最终非妊娠组5例患者死亡;妊娠组孕妇无死亡,但仅有2例孕妇顺利分娩活胎。其中1例新生儿诊断LM败血症(早发型),经青霉素钠联合美罗培南抗感染后基本病愈。结论LM感染易误诊漏诊,妊娠期早期及时准确的治疗可避免妊娠不良结局。临床中若患者出现发热或可疑败血症时,无论免疫功能是否存在缺陷,尽早选用覆盖LM的抗菌药物及尽快明确病原学能够极大改善预后。Objective This study aimed to analyze and summarize the clinical features of Listeria monocytogenes(LM)sepsis in both non-pregnant and pregnant patients for improved clinical diagnosis and treatment strategies.Methods A retrospective investigation was conducted on 12 non-pregnant patients and 12 pregnant patients diagnosed with LM sepsis by blood cultures between October 2010 and June 2021 at Beijing Chaoyang Hospital.Results The study revealed common clinical manifestations such as fever and gastrointestinal symptoms.Notably,fetal heart abnormalities were observed in 33%(n=4)of pregnanct cases,while 41.7%(n=5)non-pregnant women with LM sepsis experienced central nervous system.The analysis indicated significant differences in white blood cell counts(×109/L)(15.44±6.59 vs.7.58±3.89,P=0.002),neutrophil counts(×109/L)(11.94±6.17 vs.6.45±3.65,P=0.015),and lymphocyte counts(×109/L)(2.32±1.39 vs.0.66±0.55,P=0.001)between pregnant and non-pregnant patients.Moreover,C-reactive protein levels(mg/L)were higher in non-pregnant patients[13.35(35.28)vs 42.5(161.23),P=0.011].Initial empirical treatments in both groups mainly involved cephalosporins.Adjusted treatment after LM diagnosis by blood cultures resulted in 5 deaths among non-pregnant patients,whereas there were no deaths in the pregnant group,with 2 successful smooth deliveries,One newborn was diagnosed with early-onset Listeria septicemia,recovering after treatment with penicillin sodium and Meropenem.Conclusions This study indicated the importance of timely and accurate treatment of LM infection,particularly during early pregnancy,to mitigate adverse pregnancy outcomes.Clinically,the use of antibacterial drugs targeting listeria monocytogenes and prompt etiological clarification can significantly improve patient prognosis during fever or suspected sepsis,regardless of immune status.

关 键 词:妊娠 单核细胞增生李斯特菌 败血症 临床特征 

分 类 号:R517.7[医药卫生—内科学]

 

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