Manfredi R, Nanetti A, Ferri M, Chiodo F
Department of Clinical and Experimental Medicine, University of Bologna, S. Orsola Hospital, Italy.
Eur J Clin Microbiol Infect Dis. 2000 Apr;19(4):248-53. doi: 10.1007/s100960050471.
Clinical charts of 2,398 consecutive HIV-infected patients hospitalized over an 8-year period were reviewed retrospectively to identify all cases of Serratia infection and to evaluate the occurrence and outcome of these cases according to several epidemiological. clinical, and laboratory parameters. Seventeen of 2,398 (0.71%) patients developed Serratia marcescens infections: nine had septicaemia, six had pneumonia, one had a lymph node abscess, and one had cellulitis. All patients were severely immunocompromised, as evidenced by a mean CD4+ lymphocyte count of < 70 cells/microl and a frequent diagnosis of AIDS (13 patients). When compared with other disease localizations, septicaemia was related to a significantly lower CD4+ cell count and a more frequent occurrence of neutropaenia. Antibiotic, corticosteroid, or cotrimoxazole treatment was frequently carried out during the month preceding disease onset. Hospital-acquired Serratia spp. infection was more frequent than community-acquired infection and was significantly related to AIDS, neutropaenia, and sepsis. Antimicrobial sensitivity testing showed complete resistance to ampicillin and cephalothin but elevated susceptibility to ureidopenicillins, second- and third-generation cephalosporins, aminoglycosides, quinolones, and cotrimoxazole. An appropriate antimicrobial treatment attained clinical and microbiological cure in all cases, in absence of related mortality or relapses. Since only 13 episodes of HIV-associated Serratia spp. infection have been described until now in nine different reports (7 patients with pneumonia, 3 with sepsis, 1 with endophthalmitis, 1 with perifolliculitis, and 1 with cholecystitis), our series represents the largest one dealing with Serratia marcescens infection during HIV disease. Serratia marcescens may be responsible for appreciable morbidity among patients with HIV disease, especially when a low CD4 + cell count, neutropaenia, and hospitalization are present. The clinician and the microbiologist facing a severely immunocompromised HIV-infected patient with a suspected bacterial disease should consider the Serratia spp. organisms. In fact, a rapid diagnosis and an adequate and timely treatment can avoid disease relapses and mortality.
回顾性分析了8年间连续住院的2398例HIV感染患者的临床病历，以确定所有沙雷氏菌感染病例，并根据多种流行病学、临床和实验室参数评估这些病例的发生情况和结局。2398例患者中有17例（0.71%）发生了粘质沙雷氏菌感染：9例发生败血症，6例发生肺炎，1例发生淋巴结脓肿，1例发生蜂窝织炎。所有患者均有严重免疫功能低下，平均CD4 + 淋巴细胞计数<70个/微升以及频繁诊断为艾滋病（13例患者）可证明这一点。与其他疾病部位相比，败血症与明显更低的CD4 + 细胞计数以及更频繁发生的中性粒细胞减少症有关。在疾病发作前一个月内经常进行抗生素、皮质类固醇或复方新诺明治疗。医院获得性沙雷氏菌属感染比社区获得性感染更常见，并且与艾滋病、中性粒细胞减少症和败血症显著相关。抗菌药敏试验显示对氨苄西林和头孢噻吩完全耐药，但对脲基青霉素、第二代和第三代头孢菌素、氨基糖苷类、喹诺酮类和复方新诺明敏感性增加。在没有相关死亡或复发的情况下，适当的抗菌治疗在所有病例中均实现了临床和微生物学治愈。由于迄今为止在9份不同报告中仅描述了13例HIV相关沙雷氏菌属感染发作（7例肺炎患者、3例败血症患者、1例眼内炎患者、1例毛囊周炎患者和1例胆囊炎患者），我们的系列代表了HIV疾病期间处理粘质沙雷氏菌感染的最大系列。粘质沙雷氏菌可能是HIV疾病患者中相当一部分发病的原因，特别是当存在低CD4 + 细胞计数、中性粒细胞减少症和住院情况时。面对疑似细菌性疾病的严重免疫功能低下的HIV感染患者，临床医生和微生物学家应考虑沙雷氏菌属微生物。事实上，快速诊断以及充分及时的治疗可以避免疾病复发和死亡。
