Ko W C, Lee H C, Chuang Y C, Liu C C, Wu J J
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
J Infect. 2000 May;40(3):267-73. doi: 10.1053/jinf.2000.0654.
Aeromonas bacteraemia is not a common infectious disease, but can cause a grave outcome in infected cases. In this study, clinical presentations and prognostic factors of cases of monomicrobial Aeromonas bacteraemia were analysed. Also, the impact of beta-lactam and aminoglycoside in combination and of emerging cephalosporin-resistance during therapy was discussed.
From 1989 to 1998 in a medical centre in southern Taiwan, those cases with monomicrobial Aeromonas bacteraemia were included for study.
A total of 104 episodes of monomicrobial Aeromonas bacteraemia, accounting for 74% of all Aeromonas bacteraemia, were encountered. The infections usually occurred in the patients with hepatic cirrhosis (54%) or malignancy (21%) and were community-acquired (74%). Cases of community-acquired bacteraemia were more likely to have cirrhosis, a high severity score at onset, and a worse prognosis than those of nosocomial bacteraemia did and nosocomial isolates were less susceptible to cefoxitin and cefotaxime. Forty-three percent of cases had a concomitant infection focus, such as primary peritonitis, invasive cellulitis or necrotizing fasciitis, biliary tract or burn wound infections. Crude fatality rate within 2 weeks after the onset was 30%. Secondary bacteraemia and a higher severity score ( > or = 4) for illness at the first presentation were independently associated with a fatal outcome. The therapeutic superiority of beta-lactam and aminoglycoside in combination cannot be demonstrated in patients with Aeromonas bacteraemia. Cefotaxime resistance emerged in 3.4% of 58 patients treated with a cephalosporin for at least 72 h. None of the community-acquired isolates, but one-quarter of the nosocomial isolates, were resistant to cefotaxime.
Aeromonas bacteraemia usually occurred in patients with liver cirrhosis or malignancy, and heralded a poor prognosis, especially while associated with a relevant infectious source or with a higher severity score at presentation. The superiority of aminoglycoside and beta-lactam in combination cannot be demonstrated while treating those patients, and the emergence of antimicrobial resistance to cephalosporin was a rare event during cephalosporin therapy. Thus, a broad-spectrum cephalosporin remains one of the antimicrobial alternatives for invasive community-acquired Aeromonas infections.
气单胞菌血症并非常见的传染病，但可导致感染病例出现严重后果。本研究分析了单微生物气单胞菌血症病例的临床表现和预后因素。此外，还讨论了β-内酰胺类与氨基糖苷类联合使用以及治疗期间新出现的头孢菌素耐药性的影响。
1989年至1998年在台湾南部的一个医疗中心，纳入单微生物气单胞菌血症病例进行研究。
共遇到104例单微生物气单胞菌血症发作，占所有气单胞菌血症的74%。感染通常发生在肝硬化患者（54%）或恶性肿瘤患者（21%）中，且为社区获得性感染（74%）。与医院获得性菌血症相比，社区获得性菌血症病例更易发生肝硬化，起病时严重程度评分更高，预后更差，且医院分离株对头孢西丁和头孢噻肟的敏感性较低。43%的病例有伴随感染灶，如原发性腹膜炎、侵袭性蜂窝织炎或坏死性筋膜炎、胆道或烧伤创面感染。起病后2周内的粗死亡率为30%。继发性菌血症和首次就诊时疾病严重程度评分较高（≥4）与死亡结局独立相关。在气单胞菌血症患者中，无法证明β-内酰胺类与氨基糖苷类联合使用具有治疗优势。在58例接受头孢菌素治疗至少72小时的患者中，3.4%出现了头孢噻肟耐药。社区获得性分离株均无头孢噻肟耐药，但医院分离株中有四分之一对头孢噻肟耐药。
气单胞菌血症通常发生在肝硬化或恶性肿瘤患者中，预示预后不良，尤其是与相关感染源或就诊时严重程度评分较高相关时。在治疗这些患者时，无法证明氨基糖苷类与β-内酰胺类联合使用具有优势，且在头孢菌素治疗期间出现头孢菌素耐药的情况罕见。因此，广谱头孢菌素仍是侵袭性社区获得性气单胞菌感染的抗菌药物选择之一。
