Udaka Tsuyoshi, Hiraki Nobuaki, Shiomori Teruo, Miyamoto Hiroshi, Fujimura Takeyuki, Inaba Tsuyoshi, Suzuki Hideaki
Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
J Infect. 2007 Apr;54(4):343-8. doi: 10.1016/j.jinf.2005.06.015. Epub 2006 Sep 7.
Eikenella corrodens (E. corrodens) is a Gram-negative facultative anaerobic bacillus that originally was thought to be an attenuated and indigenous bacterium. In recent years, a number of reports have documented that E. corrodens can be a potential pathogen not only in immunocompromised patients but also in hosts with normal immunity. We herein study E. corrodens infections of the head and neck encountered in our department.
Twenty-two consecutive patients treated in our department for E. corrodens infections of the head and neck were retrospectively analyzed. Microbial specimens were subjected to light microscopic examination, aerobic culture using chocolate and sheep blood agar media, and anaerobic culture using Brucella HK agar medium. Cultured bacteria were subjected to antimicrobial susceptibility tests by means of the broth microdilution method.
There were 16 males and 6 females with an average age of 29.9 years. Two patients had malignancy, while the other patients had no particular risk factors or underlying diseases. Infected sites were the ear in 6 cases, pharynx in 12 cases (tonsil in 10 cases), paranasal sinuses in 3 cases, and salivary gland in 1 case. Seventeen patients suffered polymicrobial infections. Staphylococcus and Streptococcus were the most frequently detected pathogens coexisting with E. corrodens, and mixed infections of E. corrodens and Streptococcus milleri group bacteria were prone to form abscesses. Isolated E. corrodens was susceptible to third-generation cephems (MIC90 = 0.15-0.25 microg/ml), carbapenems (MIC90 < or = 0.15 microg/ml), and new quinolones (MIC90 < or = 0.15 microg/ml), and resistant to oxacillin (MIC90 > 8 microg/ml), cefazolin (MIC90 > 4 microg/ml), macrolides (MIC90 = 4-8 microg/ml), and clindamycin (MIC90 > 4 microg/ml).
E. corrodens infections of the head and neck occur most frequently in the tonsil even in hosts with normal immunity. Coexistence with Streptococcus milleri group bacteria and the use of ineffective antibiotics can be exacerbating factors. First-choice drugs for E. corrodens infections should be third-generation cephems, carbapenems, or new quinolones.
腐蚀埃肯菌是一种革兰氏阴性兼性厌氧杆菌，最初被认为是一种减毒的本土细菌。近年来，许多报告表明，腐蚀埃肯菌不仅在免疫功能低下的患者中，而且在免疫功能正常的宿主中都可能是潜在病原体。我们在此研究我院遇到的头颈部腐蚀埃肯菌感染情况。
对我院连续收治的22例头颈部腐蚀埃肯菌感染患者进行回顾性分析。微生物标本进行光学显微镜检查，使用巧克力和羊血琼脂培养基进行需氧培养，使用布鲁氏菌HK琼脂培养基进行厌氧培养。培养的细菌采用肉汤微量稀释法进行药敏试验。
患者中男性16例，女性6例，平均年龄29.9岁。2例患者患有恶性肿瘤，其他患者无特殊危险因素或基础疾病。感染部位：耳部6例，咽部12例（扁桃体10例），鼻窦3例，唾液腺1例。17例患者为混合感染。葡萄球菌和链球菌是与腐蚀埃肯菌共存时最常检测到的病原体，腐蚀埃肯菌与米勒链球菌群细菌的混合感染易形成脓肿。分离出的腐蚀埃肯菌对第三代头孢菌素（MIC90 = 0.15 - 0.25微克/毫升）、碳青霉烯类（MIC90≤0.15微克/毫升）和新型喹诺酮类（MIC90≤0.15微克/毫升）敏感，对苯唑西林（MIC90＞8微克/毫升）、头孢唑林（MIC90＞4微克/毫升）、大环内酯类（MIC90 = 4 - 8微克/毫升）和克林霉素（MIC90＞4微克/毫升）耐药。
即使在免疫功能正常的宿主中，头颈部腐蚀埃肯菌感染最常发生在扁桃体。与米勒链球菌群细菌共存以及使用无效抗生素可能是加重因素。腐蚀埃肯菌感染的首选药物应为第三代头孢菌素、碳青霉烯类或新型喹诺酮类。
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