Al-Sabah S, Goldberg P, Qureshi S T
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Transpl Infect Dis. 2007 Sep;9(3):233-6. doi: 10.1111/j.1399-3062.2006.00192.x.
Severe sepsis and progression to septic shock in solid organ transplant recipients is associated with a high mortality. We describe a fulminant case of septic shock in a liver transplant recipient caused by Pasteurella multocida, a gram-negative coccobacillus most commonly associated with domestic cats and dogs. P. multocida is a rare cause of bacteremia and has not been reported as a cause of septic shock following liver transplantation. In addition to standard therapy, the patient was managed with drotrecogin alpha (activated) recombinant activated protein C (APC), an evidence-based agent that has been shown to significantly improve outcome in severe sepsis in the non-transplant population. The known risk factors, clinical course, and outcomes of severe infection associated with P. multocida are also briefly reviewed. This case illustrates the need for transplant recipients and their healthcare providers to carefully consider the risk of severe infection associated with domestic animal exposure.
实体器官移植受者发生严重脓毒症并进展为感染性休克，死亡率很高。我们描述了一例肝移植受者因多杀巴斯德菌引发的暴发性感染性休克病例，多杀巴斯德菌是一种革兰氏阴性球杆菌，最常见于家猫和家犬。多杀巴斯德菌是菌血症的罕见病因，尚未见其作为肝移植后感染性休克病因的报道。除了标准治疗外，该患者还接受了重组人活化蛋白C（drotrecogin alpha，活化型）治疗，这是一种循证药物，已证明可显著改善非移植人群严重脓毒症的预后。文中还简要回顾了与多杀巴斯德菌相关的严重感染的已知危险因素、临床病程及转归。该病例表明，移植受者及其医护人员需要仔细考虑与接触家畜相关的严重感染风险。
