1例星座链球菌致患者眼眶蜂窝织炎伴血流感染的诊疗分析  

Analysis of Diagnosis and Treatment of One Patient with Orbital Cellulitis and Bloodstream Infection Caused by Streptococcus Constellatus

作　　者：孙桂英 倪晓艳 李颖 徐溯 SUN Gui-ying;NI Xiao-yan;LI Ying;XU Su(Department of Infection Management,Suzhou Ninth People's Hospital,Suzhou Jiangsu 215200,China;Institute of Antibiotics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]苏州市第九人民医院感染管理科,江苏苏州215200 [2]复旦大学附属华山医院抗生素研究所,上海200040

出　　处：《抗感染药学》2024年第11期1092-1097,共6页Anti-infection Pharmacy

摘　　要：目的:分析1例星座链球菌致患者眼眶蜂窝织炎伴血流感染的诊治过程,为临床类似患者的诊断和治疗提供参考。方法与结果:患者(男,60岁)因“右眼红肿10 d伴化脓1周”而入院治疗;入院查体示,患者右眼肿胀严重,并可见较多黄白色脓性分泌物;血清实验室检查结果显示,白细胞计数、中性粒细胞百分比、C反应蛋白、降钙素原等感染指标均偏高;考虑眼部感染的病原菌多为革兰阳性菌,但不排除合并颅内感染,遂经验性予利奈唑胺+哌拉西林-他唑巴坦钠,并辅以清创引流;次日,患者血培养检出星座链球菌,而第3天的脓性分泌物标本中亦检出星座链球菌,且药敏结果提示其对青霉素、红霉素、克林霉素、左氧氟沙星、头孢唑肟均敏感;综合患者平时血糖控制不佳、口腔卫生较差和存在慢性鼻窦炎等情况,考虑星座链球菌为此次感染的致病菌,并排除甲氧西林耐药的金黄色葡萄球菌感染的可能,故停用利奈唑胺,但考虑当前哌拉西林-他唑巴坦钠抗菌作用良好,故继续延用;经过13 d的抗感染治疗,患者右眼的红肿、化脓等症状和感染指标均明显好转。结论:星座链球菌作为体表和口鼻腔的常见细菌,对正常人较少引发感染,但对基础条件较差的人群其感染风险将显著升高;对此,临床应做好病原菌的判别,从而为针对性地抗感染治疗提供指导。Objective:To analyze the diagnosis and treatment process of one patient with orbital cellulitis and bloodstream infection caused by Streptococcus constellatus,and provide a reference for the clinical diagnosis and treatment of similar patients.Methods and Results:The patient(male,60 years old)was admitted to the hospital due to"redness and swelling of the right eye for 10 days with suppuration for 1 week".After admission,the physical examination showed that the patient's right eye was severely swollen,with a lot of yellow-white purulent secretions;the laboratory test results of serum showed that the infection indicators such as white blood cell count,neutrophil percentage,C-reactive protein,procalcitonin,etc.were slightly high.Considering that the pathogens of eye infection were mostly Gram-positive bacteria and the combined intracranial infection could not be ruled out,linezolid+piperacillin-tazobactam sodium was given empirically,supplemented with debridement and drainage;on the next day,the blood culture result showed the presence of Streptococcus constellatus;on the third day,Streptococcus constellatus was also detected in the purulent secretion specimens,and the drug susceptibility test results showed that it was sensitive to penicillin,erythromycin,clindamycin,levofloxacin,and ceftizoxime.In combination with the patient's poor blood glucose control,poor oral hygiene,and presence of chronic sinusitis,among other conditions,Streptococcus constellatus was considered to be the pathogen of this infection,and the possibility of methicillin-resistant Staphylococcus aureus infection was ruled out,so linezolid was discontinued;but piperacillin-tazobactam sodium continued to be used for its good antibacterial effect.After 13 days of anti-infection treatment,the patient's symptoms such as redness and swelling,and suppuration of right eye and the infection indicators were significantly improved.Conclusion:As a common bacterium on the body surface and in the oral and nasal cavities,Streptococcus constellatus rarely caus

关 键 词：星座链球菌 眼眶蜂窝织炎 血流感染 

分 类 号：R97[医药卫生—药品] R515[医药卫生—药学]