6例恶性肿瘤患者李斯特菌感染的临床分析  

Clinical analysis of listeria infection in 6 patients with malignant tumor

作　　者：李巧珍 张才金 林志伟 陈大朝[1] LI Qiaozhen;ZHANG Caijin;LIN Zhiwei;CHEN Dachao(Department of Oncology,the 909th Hospital,Dongnan Hospital of Xiamen University,Fujian Zhangzhou 363000,China.;Department of Respiratory Tuberculosis,the 909th Hospital,Dongnan Hospital of Xiamen University,Fujian Zhangzhou 363000,China.)

机构地区：[1]第九〇九医院,厦门大学附属东南医院肿瘤科,福建漳州363000 [2]第九〇九医院,厦门大学附属东南医院呼吸结核科,福建漳州363000

出　　处：《现代肿瘤医学》2024年第6期1120-1124,共5页Journal of Modern Oncology

摘　　要：目的:提高对恶性肿瘤患者并发罕见细菌感染诊断和治疗的认识。方法:报道6例恶性肿瘤患者并发单核细胞增生性李斯特菌感染的临床资料,对其医源性因素、临床表现、确诊病原学、治疗和转归进行分析。结果:6例患者均有恶性肿瘤病史,女性占4例;3例发生于实体癌,3例发生于血液肿瘤。5例患者发病前接受化疗和/或放疗措施。6例患者临床表现均出现发热,出现血流感染5例,中枢神经系统感染4例,2例伴有胃肠炎。6例患者均从血液和/或脑脊液培养获得病原学证据。初始经验性治疗有5例患者选用第三代头孢菌素,病原学确诊后调整抗生素治疗,6例患者中3例应用氨苄西林或哌拉西林他唑巴坦治疗均获得治愈。结论:恶性肿瘤患者李斯特菌感染的发病率和死亡率更高,当出现持续性发热、血流感染和中枢神经系统症状,且头孢菌素和喹诺酮类抗菌药物治疗欠佳时,要高度警惕李斯特菌感染的可能。应早期进行病原微生物学诊断和足量足疗程使用氨苄西林等抗生素治疗。Objective:To better understand the diagnosis and treatment of rare bacterial infections in patients with malignant tumors.Methods:6 patients with malignant tumor complicated with listeria monocytogenes infection were reported.The iatrogenic factors,clinical characteristics,confirmed etiology,treatment and outcome were analyzed.Results:All the 6 patients had a history of malignant tumor,4 patients were female.3 cases were solid carcinomas and 3 cases were hematologic malignancies.5 cases received chemotherapy and/or radiotherapy before listeria infection.All the 6 patients had clinical manifestations of fever.The bloodstream infections occurred in 5 cases.The central nervous system infections occurred in 4 cases,and gastroenteritis occurred in 2 cases.All the 6 patients received etiological evidence from blood culture and/or CSF culture.5 cases selected the third-generation cephalosporin for the empirical treatment,and then antibiotic therapy was adjusted in all cases after diagnosis of etiology.Among the 6 patients,3 cases were cured by ampicillin or piperacillin-tazobactam.Conclusion:The incidence and mortality of listeria infection are higher in patients with malignant tumors.When the patient has a persistent fever,bloodstream infection,central nervous system infection and the empirical antibiotics such as cephalosporins and quinolones failed,we should consider whether it is listeria infection.Early diagnosis of pathogeny microbiology,sufficient dosage and course of treatment with ampicillin and other antibiotics should be carried out.

关 键 词：单核细胞增生性李斯特菌 恶性肿瘤 血流感染 脑膜炎 

分 类 号：R730.6[医药卫生—肿瘤]