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耐多药脑膜败血性伊丽莎白菌和粪肠球菌感染一例血液肿瘤科患者

Multidrug-Resistant Elizabethkingia meningoseptica and Enterococcus faecium Infection in an Oncohematologic Patient.

机构信息

Department of Clinical Analysis, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, AM, Brazil.

Patient Care Department, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, AM, Brazil.

出版信息

Am J Case Rep. 2024 Nov 22;25:e945360. doi: 10.12659/AJCR.945360.

Abstract

BACKGROUND This case report describes a case of a 25-year-old man who underwent a surgical procedure and was subsequently diagnosed with acute myeloid leukemia. Following his immediate admission to a specialized hospital unit for hematology and hemotherapy to receive chemotherapy, he was found to have a concurrent infection with multidrug-resistant Elizabethkingia meningoseptica as well as Enterococcus faecium. Both isolates are commonly associated with healthcare-associated infections. CASE REPORT The patient described in this report underwent an exploratory laparotomy, which is an invasive surgical procedure, and was subsequently diagnosed with acute myeloid leukemia following a biopsy. Chemotherapy was initiated immediately, during which the patient developed clinical signs and symptoms of infection. Blood cultures revealed the presence of Enterococcus faecium, while urine cultures identified Elizabethkingia meningoseptica. The VITEK-2 antibiogram for both bacteria revealed a multidrug resistance profile. E-test performed for glycopeptides indicated high-level resistance, with a minimum inhibitory concentration (MIC) exceeding 256 µg/mL. Prophylactic antibiotic therapy was initiated and subsequently adjusted according to the culture and antibiogram results. CONCLUSIONS Use of proper aseptic techniques during medical procedures is essential. Patients with severely compromised immunity undergoing numerous procedures require strict isolation measures to prevent infections, which can make the difference between life and death. Early laboratory identification of pathogenic clones and their antimicrobial resistance profiles is crucial for timely etiological diagnosis. This helps prevent the spread of infections and hospital infection outbreaks.

摘要

背景 本病例报告描述了一名 25 岁男性的病例,该患者接受了手术治疗,随后被诊断患有急性髓系白血病。在他立即被收入血液科和血液化疗专科病房接受化疗后,发现他同时感染了耐多药伊丽莎白菌和屎肠球菌。这两种分离株通常与医疗保健相关感染有关。 病例报告 本报告中描述的患者接受了剖腹探查术,这是一种侵入性手术,随后在活检后被诊断为急性髓系白血病。立即开始化疗,在此期间患者出现感染的临床症状和体征。血培养显示屎肠球菌,而尿液培养鉴定出伊丽莎白菌。两种细菌的 VITEK-2 抗生素谱显示出多药耐药性。糖肽类的 E 试验表明高度耐药,最小抑菌浓度(MIC)超过 256μg/ml。根据培养和抗生素谱结果开始预防性抗生素治疗,并随后进行调整。 结论 在医疗程序中使用适当的无菌技术至关重要。接受多次手术且免疫严重受损的患者需要严格的隔离措施以预防感染,这可能是生死攸关的区别。早期对致病性克隆及其抗菌药物耐药性进行实验室鉴定对于及时进行病因诊断至关重要。这有助于防止感染的传播和医院感染的爆发。

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